Individual
BENJAMIN PHILIP FORTNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10315 DAWSONS CREEK BLVD STE AB, FORT WAYNE, IN 46825-1912
(260) 436-7875
(260) 432-9812
Mailing address
PO BOX 843603, DALLAS, TX 75284-0001
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01080939A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11018622A
MEDICAL RESIDENCY PERMIT
IN
01
—
4301107343
BOARD OF MEDICINE- PHYSICIAN- EDUCATIONAL LIMITED
MI
01
—
5315070194
BOARD OF PHARMACY- CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
04/17/2015
Last updated
05/16/2023
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