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Individual
DARRYL L FORTSON
Active
Individual
DARRYL L FORTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M D
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01037803
IN
207Q00000X
Family Medicine Physician
01037803A
IN
207Q00000X
Family Medicine Physician
Primary
15697
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000359839
ANTHEM, BC/BS PROVIDER
IN
05
—
200004090B
—
IN
01
—
V112580-V112581
PTAN
NV
01
—
V113132
SMA MEDICARE
NV
Enumeration date
10/05/2006
Last updated
01/17/2017
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