Healthcare Provider Details

I. General information

NPI: 1073426508
Provider Name (Legal Business Name): FORSYTHE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MALABAR RD NE
PALM BAY FL
32907-2506
US

IV. Provider business mailing address

1425 MALABAR RD NE
PALM BAY FL
32907-2506
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 Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DAVID JOHN FORSYTHE
Title or Position: OWNER
Credential: MD
Phone: 321-490-4960