Healthcare Provider Details

I. General information

NPI: 1073501599
Provider Name (Legal Business Name): CURTIS FLOYD FORST MPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 HENNEPIN AVE N
GLENCOE MN
55336-1416
US

IV. Provider business mailing address

1805 HENNEPIN AVE N
GLENCOE MN
55336-1416
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-3121
  • Fax: 320-864-7887
Mailing address:
  • Phone: 320-864-3121
  • Fax: 320-864-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9426
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: