Individual
DR. GRADY AUSBUR FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
554 KEILY STREET, JACKSONVILLE, FL 32212
(757) 953-7550
(757) 953-7560
Mailing address
PO BOX 25578, BARRIGADA, GU 96921-5578
(671) 480-7934
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0116027243
VA
207P00000X
Emergency Medicine Physician
Primary
M-2191
GU
Other
Enumeration date
03/12/2014
Last updated
12/17/2019
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