Healthcare Provider Details

I. General information

NPI: 1245527951
Provider Name (Legal Business Name): THERON FORSHEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 N.W. 39TH ST. SUITE 103
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

3115 SE 21ST ST
DEL CITY OK
73115-1531
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-9668
  • Fax: 405-606-7893
Mailing address:
  • Phone: 702-403-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number304273
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: