Individual
ANTHONY LEE FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, RADIOLOGY, JACKSON, MS 39216-4500
(601) 984-2500
Mailing address
2500 N STATE ST, RADIOLOGY, JACKSON, MS 39216-4500
(601) 984-2500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
26214
MS
2085R0202X
Diagnostic Radiology Physician
T-3337
MS
Other
Enumeration date
03/27/2017
Last updated
08/07/2023
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