Healthcare Provider Details

I. General information

NPI: 1417070707
Provider Name (Legal Business Name): FORREST O BEATY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 ANDERSON RD
FORESTVILLE CA
95436-9629
US

IV. Provider business mailing address

PO BOX 1427
FORESTVILLE CA
95436-1427
US

V. Phone/Fax

Practice location:
  • Phone: 707-887-7597
  • Fax: 707-887-7669
Mailing address:
  • Phone: 707-887-7597
  • Fax: 707-887-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA024751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: