Healthcare Provider Details

I. General information

NPI: 1700224664
Provider Name (Legal Business Name): JENNIFER E FORTE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 14TH ST
PUEBLO CO
81003-2710
US

IV. Provider business mailing address

PO BOX 560825
DENVER CO
80256-0825
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7585
  • Fax: 719-595-7589
Mailing address:
  • Phone: 719-595-7580
  • Fax: 719-545-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDR.0053938
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4626
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: