Provider Demographics
NPI:1235225780
Name:FORTIN, CLAUDE J (MD)
Entity type:Individual
Prefix:
First Name:CLAUDE
Middle Name:J
Last Name:FORTIN
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:751 MALETA LN STE 104
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7606
Mailing Address - Country:US
Mailing Address - Phone:720-465-8565
Mailing Address - Fax:949-561-4369
Practice Address - Street 1:751 MALETA LN STE 104
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7606
Practice Address - Country:US
Practice Address - Phone:720-465-8565
Practice Address - Fax:949-561-4369
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0671712084N0400X
IN01033169A2084N0400X
CAG-1756042084N0400X
FLME1536942084N0400X
IAMD-529382084N0400X
IDMC24382084N0400X
NV248982084N0400X
TN689192084N0400X
TXU15942084N0400X
VA01012840742084N0400X
WAIMLC.MD615610452084N0400X
AZ690282084N0400X
MEMD259132084N0400X
COCDRH.00570332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067171Medicaid