Individual
DR. DARRELL LEE FORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97470-6523
(541) 440-1000
Mailing address
1464 SE KANE ST, ROSEBURG, OR 97470-4235
(541) 957-8570
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21698
KY
Other
Enumeration date
08/11/2006
Last updated
07/08/2007
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