Healthcare Provider Details

I. General information

NPI: 1699082727
Provider Name (Legal Business Name): ROY LOUIS FORSYTHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SW 10TH ST
OKLAHOMA CITY OK
73109-5610
US

IV. Provider business mailing address

3805 RIDGEWOOD DR
EDMOND OK
73013-8034
US

V. Phone/Fax

Practice location:
  • Phone: 405-236-0701
  • Fax: 405-236-0773
Mailing address:
  • Phone: 405-359-0525
  • Fax: 404-359-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number44
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: