Healthcare Provider Details

I. General information

NPI: 1033125935
Provider Name (Legal Business Name): SHANON ALEX FORSETER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST STE 230
DENVER CO
80205-5507
US

IV. Provider business mailing address

5314 STONEYBROOK DR
BROOMFIELD CO
80020-6167
US

V. Phone/Fax

Practice location:
  • Phone: 303-200-1131
  • Fax: 303-839-7761
Mailing address:
  • Phone: 314-757-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2002023834
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60580
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: