Healthcare Provider Details

I. General information

NPI: 1467434936
Provider Name (Legal Business Name): SONJA LOUISE FORRISTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E YOUNG ST
LLANO TX
78643-1344
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 325-247-4131
  • Fax: 325-248-2099
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH4329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: