Provider Demographics
NPI:1922098375
Name:FORTUNE, ROBERT LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LLOYD
Last Name:FORTUNE
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 1:9290 E THOMPSON PEAK PKWY
Mailing Address - Street 2:UNIT 257
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4507
Mailing Address - Country:US
Mailing Address - Phone:480-518-1922
Mailing Address - Fax:
Practice Address - Street 1:9290 E THOMPSON PEAK PKWY
Practice Address - Street 2:UNIT 257
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4507
Practice Address - Country:US
Practice Address - Phone:480-518-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ135402086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105643Medicare ID - Type UnspecifiedGROUP
AZE39136Medicare UPIN
AZ105644Medicare ID - Type UnspecifiedINDIVIDUAL PHYSICIAN