Healthcare Provider Details

I. General information

NPI: 1578629325
Provider Name (Legal Business Name): DAVID FORSYTHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N FLAMINGO RD
PEMBROKE PINES FL
33028-1006
US

IV. Provider business mailing address

703 N FLAMINGO RD
PEMBROKE PINES FL
33028-1006
US

V. Phone/Fax

Practice location:
  • Phone: 321-490-4960
  • Fax: 321-616-8222
Mailing address:
  • Phone: 321-490-4960
  • Fax: 321-616-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME108823
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberME108823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: