Healthcare Provider Details

I. General information

NPI: 1700170578
Provider Name (Legal Business Name): JEFFREY ROBERT FORBES L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MAIN AVE
SAN ANTONIO TX
78205-1204
US

IV. Provider business mailing address

610 NORTH MAIN, SECOND FLOOR
SAN ANTONIO TX
78205-1204
US

V. Phone/Fax

Practice location:
  • Phone: 210-392-9087
  • Fax: 210-225-1486
Mailing address:
  • Phone: 210-237-4444
  • Fax: 210-828-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: