Healthcare Provider Details

I. General information

NPI: 1396783726
Provider Name (Legal Business Name): DARREL RICHARD FORSLUND JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 W 4TH ST
SPENCER IA
51301-3006
US

IV. Provider business mailing address

1915 W 4TH ST
SPENCER IA
51301-3006
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-5479
  • Fax:
Mailing address:
  • Phone: 712-262-5479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27694
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR0061273
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: