Provider Demographics
NPI:1669437091
Name:PETER L. FORT, MD PA
Entity type:Organization
Organization Name:PETER L. FORT, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-794-3900
Mailing Address - Street 1:5955 17TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7836
Mailing Address - Country:US
Mailing Address - Phone:941-794-3900
Mailing Address - Fax:941-794-8810
Practice Address - Street 1:5955 17TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7836
Practice Address - Country:US
Practice Address - Phone:941-794-3900
Practice Address - Fax:941-794-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FL49343Medicare PIN