MEDICARE: DR. JEAN FORSBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician	18926	OK

General Provider Information

NPI Number	:	1417910597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN FORSBERG M.D.

Provider Business Mailing Address
First Line	:	6013 KINGSBRIDGE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-3208
Country	:	US
Telephone Number	:	405-721-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N LINCOLN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3251
Country	:	US
Telephone Number	:	405-297-5756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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