Individual
DR. SAMUEL L. FORT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
203B MOCKSVILLE AVE, SALISBURY, NC 28144-3325
(704) 636-0971
(704) 636-8854
Mailing address
PO BOX 2145, 203 B MOCKSVILLE AVENUE, SALISBURY, NC 28145-2145
(704) 636-0971
(704) 636-8554
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
9501242
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33148
BCBS
—
05
—
8933148
—
NC
Enumeration date
04/13/2006
Last updated
07/08/2007
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