Provider Demographics
NPI:1265479646
Name:FOURNIER, GEORGE A (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:FOURNIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4011
Mailing Address - Country:US
Mailing Address - Phone:954-492-1177
Mailing Address - Fax:954-492-0352
Practice Address - Street 1:2466 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4011
Practice Address - Country:US
Practice Address - Phone:954-492-1177
Practice Address - Fax:954-492-0352
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51944207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05675OtherBCBS FLORIDA
FLP00396481OtherRAILROAD MEDICARE
FL$$$$$$$$$OtherTRICARE
FL05675OtherBCBS FLORIDA
FLP00396481OtherRAILROAD MEDICARE