Fortenberry, Dewitt Charles

Fortenberry, Dewitt Charles is an sole proprietor health care provider with primary practice located at 2602 Saint Michael Dr Suite 302, Texarkana TX 75503-2387. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Fortenberry, Dewitt Charles can be contacted via phone (903) 336-2391.

Contact Information

Primary practice address
2602 Saint Michael Dr Suite 302 Texarkana TX 75503-2387
Phone: (903) 336-2391
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X L8691 Texas
Allopathic & Osteopathic Physicians / General Practice 208D00000X L8691 Texas

Profile Details

NPI number 1114960473
LBN Legal business name Fortenberry, Dewitt Charles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 14th, 2006
Last updated Sep 17th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114960473 NPPES
Texas MEDICAID 167594401

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