MEDICARE: JENNIFER ANNE FORSYTH 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	WAITING FOR APPROVAL	KS

General Provider Information

NPI Number	:	1881853760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANNE FORSYTH M.D.

Provider Business Mailing Address
First Line	:	5225 MAPLE AVE APT 4109
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-8458
Country	:	US
Telephone Number	:	972-800-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 MAPLE AVE APT 4109
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-8458
Country	:	US
Telephone Number	:	972-800-9200
Fax Number	:

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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