Individual
DR. GRADY REYNOLDS FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1140 MAIN ST, LIVINGSTON MEDICAL GROUP, LIVINGSTON, CA 95334-1257
(209) 394-7913
Mailing address
116 W. MINNESOTA AVE, MCCLOUD, CA 96057
(530) 964-2389
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G27353
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982765582
—
CA
Enumeration date
12/13/2006
Last updated
08/14/2024
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