Healthcare Provider Details

I. General information

NPI: 1023391661
Provider Name (Legal Business Name): SCOTT DAVID FORRESTER C.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MARGRAVE DR
RENO NV
89502-3542
US

IV. Provider business mailing address

615 MARGRAVE DR
RENO NV
89502-3542
US

V. Phone/Fax

Practice location:
  • Phone: 775-657-9500
  • Fax: 775-657-9502
Mailing address:
  • Phone: 775-657-9500
  • Fax: 775-657-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: