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Individual

PHILLIP L FORTENBERRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
311 CAMDEN ST, SUITE 208, SAN ANTONIO, TX 78215-2012
(210) 892-0228
(210) 455-0169
Mailing address
311 CAMDEN ST, SUITE 208, SAN ANTONIO, TX 78215-2012
(210) 892-0228
(210) 694-0035

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L5336
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
173424603
TX
Enumeration date
05/26/2006
Last updated
10/04/2011
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