Individual
DUSTIN GARRETT FORTADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
1025 E MAIN ST, MEDFORD, OR 97504-7448
(541) 779-1282
Mailing address
1003 E MAIN ST STE 104, MEDFORD, OR 97504-7140
(541) 779-1282
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/14/2018
Last updated
03/14/2018
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