Individual
BRIAN J FORTIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
46 FAIRVIEW AVE, SKOWHEGAN, ME 04976-1481
(207) 474-5121
(207) 474-3441
Mailing address
PO BOX 468, SKOWHEGAN, ME 04976-0468
(207) 858-8367
(207) 474-9261
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA286
ME
363AM0700X
Medical Physician Assistant
Primary
PA286
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12255626784
—
ME
Enumeration date
06/13/2011
Last updated
06/30/2023
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