Individual
DR. STEPHEN F ORTALDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7400 W OLIVE AVE, PEORIA, AZ 85345-8889
(623) 487-8598
Mailing address
5080 SPECTRUM DR, SUITE 1200 WEST, ADDISON, TX 75001-4648
(972) 364-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31573
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31573
STATE LICENSE NUMBER
AZ
Enumeration date
02/25/2007
Last updated
01/21/2010
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