Provider Demographics
NPI:1942287347
Name:FORTIER, GEORGE MA IV (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MA
Last Name:FORTIER
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:9264 HIGHWAY 115
Mailing Address - Street 2:P O BOX 154
Mailing Address - City:RANDALL
Mailing Address - State:MN
Mailing Address - Zip Code:56475-2501
Mailing Address - Country:US
Mailing Address - Phone:320-749-2607
Mailing Address - Fax:320-749-8301
Practice Address - Street 1:9264 HIGHWAY 115
Practice Address - Street 2:
Practice Address - City:RANDALL
Practice Address - State:MN
Practice Address - Zip Code:56475-2501
Practice Address - Country:US
Practice Address - Phone:320-749-2607
Practice Address - Fax:320-749-8301
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-10-26
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Provider Licenses
StateLicense IDTaxonomies
MN34195208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1727990OtherMEDICA
MN61340OtherHEALTH PARTNERS
MN20042231OtherRAILROAD MEDICARE
MN08D3540OtherBLUE CROSS BLUE SHIELD MN
MN407262600Medicaid
MN1006228OtherPREFERRED ONE
MN1220399OtherUCARE
MN1727990OtherMEDICA
MN08D3540OtherBLUE CROSS BLUE SHIELD MN