Healthcare Provider Details

I. General information

NPI: 1699745109
Provider Name (Legal Business Name): JOHN L FORSYTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MYRTLE ST
MEDFORD OR
97504-7337
US

IV. Provider business mailing address

19 MYRTLE ST
MEDFORD OR
97504-7337
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-3863
  • Fax:
Mailing address:
  • Phone: 541-773-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD07917
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: