Individual
DR. PETER THOMAS FORTKORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5220
(910) 272-1437
Mailing address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5220
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
95-00577
NC
207R00000X
Internal Medicine Physician
Primary
9500577
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649362138
—
NC
05
—
5300138
—
NC
05
—
N00579
—
SC
Enumeration date
09/29/2006
Last updated
08/22/2019
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