Individual
DR. MARK WILBUR FORTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2255 JFK RD, DUBUQUE, IA 52002-2846
(563) 582-4357
(563) 582-5718
Mailing address
2933 WILDERNESS DR, DUBUQUE, IA 52001-1535
(563) 557-1414
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
27778
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1065847
—
IA
01
—
35557
BLUE CROSS WELLMARK BLUE
IA
Enumeration date
03/31/2006
Last updated
05/08/2013
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