Individual
JOHN JOSEPH FORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 W THOMAS RD, ATTN: ACADEMIC AFFAIRS, PHOENIX, AZ 85013-4409
(602) 406-3538
Mailing address
350 W THOMAS RD, ATTN: ACADEMIC AFFAIRS, PHOENIX, AZ 85013-4409
(602) 406-3538
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
R71961
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R71961
TRAINING PERMIT
AZ
Enumeration date
11/17/2010
Last updated
11/17/2010
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