Healthcare Provider Details

I. General information

NPI: 1083718316
Provider Name (Legal Business Name): FORREST C CLORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD VA MEDICAL CENTER
GAINESVILLE FL
32608-1197
US

IV. Provider business mailing address

14621 SW WILLISTON RD
MICANOPY FL
32667
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-6064
  • Fax: 352-379-4044
Mailing address:
  • Phone: 352-495-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME14980
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301025233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: