Individual
RICHARD FORTNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A
Contact information
Practice address
2060 W 24TH ST, YUMA, AZ 85364-6123
(928) 539-3082
(928) 539-5579
Mailing address
2060 W 24TH ST, YUMA, AZ 85364-6123
(928) 539-3082
(928) 539-5579
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1549
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043324932
CLINIC NPI
—
01
—
1063433720
CLINIC NPI
—
01
—
1245344316
CLINIC NPI
—
05
—
162355
—
AZ
01
—
1962507376
CLINIC NPI
—
Enumeration date
07/19/2006
Last updated
02/24/2014
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