Healthcare Provider Details

I. General information

NPI: 1003073438
Provider Name (Legal Business Name): JEFFREY ALAN FORQUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 11/03/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HARROUN RD STE 10
SYLVANIA OH
43560-2182
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-1952
  • Fax: 419-824-0344
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301094072
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35093336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: