Fortuin, Brian W

Fortuin, Brian W is an individual health care provider with primary practice located at 775 Pole Line Rd W Suite 302, Twin Falls ID 83301-5814. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Fortuin, Brian W can be contacted via phone (208) 814-8600.

Contact Information

Primary practice address
775 Pole Line Rd W Suite 302 Twin Falls ID 83301-5814
Phone: (208) 814-8600
Fax: (208) 814-8942
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X M7263 Idaho

Profile Details

NPI number 1740221191
LBN Legal business name Fortuin, Brian W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Dec 29th, 2014 - about 11 years ago

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 1740221191 NPPES
Idaho Other P00029395 RR MEDICARE
Idaho MEDICAID 805179600 RR MEDICARE

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