Individual
DR. FRAZIER T FORTENBERRY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101044989
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14120
COMMUNITY HEALTH
VA
01
—
204175
SOUTHERN HEALTH
VA
01
—
23555
CIGNA
VA
01
—
340000300
MEDICARE
VA
01
—
367104
MAMSI
VA
01
—
461522
ANTHEM SERVICES
VA
01
—
P00003207
MEDICARE PIN
VA
Enumeration date
09/30/2005
Last updated
07/21/2011
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