Individual
DR. GERALD RICHARD FORTUNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2728 SUNSET BLVD STE 400, WEST COLUMBIA, SC 29169-4872
(803) 936-7095
(803) 936-7908
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 936-7095
(803) 936-7908
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2016023683
MO
2086S0102X
Surgical Critical Care Physician
2016023683
MO
2086S0129X
Vascular Surgery Physician
2016023683
MO
2086S0129X
Vascular Surgery Physician
Primary
25639
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447479829
—
MO
05
—
ENROLLED
—
IL
Enumeration date
04/24/2007
Last updated
04/26/2023
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