Healthcare Provider Details

I. General information

NPI: 1952361289
Provider Name (Legal Business Name): JOHN ALEXANDER FOREST III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2874 N CARSON ST SUITE 220
CARSON CITY NV
89706-0177
US

IV. Provider business mailing address

PO BOX 2384
CARSON CITY NV
89702-2384
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-7666
  • Fax: 775-883-0115
Mailing address:
  • Phone: 775-883-7666
  • Fax: 775-883-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10456
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: