Doctor Name: | DR. DARRELL LEE FORT |
NPI Number: | 1710998794 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 21698 |
Business Practice Address: | 913 Nw Garden Valley Blvd Roseburg, OR - 974706523 |
Business Phone Number: | 5414401000 |
Business Fax Number: | |
Mailing Address: | 1464 Se Kane St, ROSEBURG |
State: | OR |
Postal Code: | 974704235 |
Phone Number: | 5419578570 |
Fax Number: | |
NPI Enumeration Date: | 08/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 21698 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |