Individual
MR. ROBIN DALE FORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5099 SPORTSMAN LAKE RD, ELIZABETHTOWN, KY 42701-8216
(270) 369-8984
(270) 369-8562
Mailing address
5099 SPORTSMAN LAKE RD, ELIZABETHTOWN, KY 42701-8216
(270) 369-8984
(270) 369-8562
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA050
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA050
KBML CERTIFICATION NO.
KY
Enumeration date
01/23/2007
Last updated
07/08/2007
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