Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G16473 | CA |
NPI | 1043381098 |
---|---|
Provider Name | Dr. Floyd D Fortuin |
First Address | San Francisco, CA 94109 |
Second Address | San Francisco, CA 94109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A39808 | (02) |