Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 89203 | GA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | P7911 | TX |
NPI | 1124037486 |
---|---|
Provider Name | Daniel Fortes |
First Address | Marietta, GA 30060-1179 |
Second Address | Marietta, GA 30060-1179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 09/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
329610501 | (05) | TX |