Healthcare Provider Details

I. General information

NPI: 1487092797
Provider Name (Legal Business Name): BRENT DANIEL FORREST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23401 PRAIRIE STAR PKWY STE B-300
LENEXA KS
66227-7268
US

IV. Provider business mailing address

23401 PRAIRIE STAR PKWY STE B-300
LENEXA KS
66227-7268
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-6319
  • Fax:
Mailing address:
  • Phone: 913-677-6319
  • Fax: 660-687-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0445968
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: