Fortuna, Gerald Richard

Fortuna, Gerald Richard is an individual health care provider with primary practice located at 2728 Sunset Blvd Ste 400 , West Columbia SC 29169-4872. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgical Critical Care, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Fortuna, Gerald Richard can be contacted via phone (803) 936-7095.

Contact Information

Primary practice address
2728 Sunset Blvd Ste 400 West Columbia SC 29169-4872
Phone: (803) 936-7095
Fax: (803) 936-7908
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 2016023683 Missouri
Allopathic & Osteopathic Physicians / Surgical Critical Care 2086S0102X 2016023683 Missouri
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 2016023683 Missouri
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 25639 South Carolina

Profile Details

NPI number 1447479829
LBN Legal business name Fortuna, Gerald Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 24th, 2007
Last updated Apr 26th, 2023 - about 2 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 1447479829 NPPES
Illinois MEDICAID ENROLLED
Illinois MEDICAID 1447479829

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