Provider Demographics
NPI:1215902820
Name:FORT, RICHARD ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLAN
Last Name:FORT
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 1:3822 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7708
Mailing Address - Country:US
Mailing Address - Phone:360-257-9646
Mailing Address - Fax:360-257-9650
Practice Address - Street 1:3822 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-7708
Practice Address - Country:US
Practice Address - Phone:360-257-9646
Practice Address - Fax:360-257-9650
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023848146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant