Provider Demographics
NPI:1952302374
Name:FORTNER, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:FORTNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1214 SPRING ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3704
Mailing Address - Country:US
Mailing Address - Phone:812-283-5950
Mailing Address - Fax:812-285-5439
Practice Address - Street 1:1214 SPRING ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3704
Practice Address - Country:US
Practice Address - Phone:812-283-5950
Practice Address - Fax:812-285-5439
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-12-13
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Provider Licenses
StateLicense IDTaxonomies
IN01023187A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND94644Medicare UPIN
IN241630CMedicare Oscar/Certification
IN241120CMedicare Oscar/Certification
IN121210CMedicare Oscar/Certification