Individual
GARY DEE FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1408 N FLORENCE AVE, CLAREMORE, OK 74017-3159
(918) 341-1044
(918) 341-7443
Mailing address
1408 N FLORENCE AVE, CLAREMORE, OK 74017-3159
(918) 341-1044
(918) 341-7443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12540
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100150500A
—
OK
Enumeration date
02/08/2006
Last updated
12/09/2010
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