Healthcare Provider Details

I. General information

NPI: 1992199467
Provider Name (Legal Business Name): DOMINIC MARIO FORTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 104
TACOMA WA
98405-5303
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 104
TACOMA WA
98405-5303
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6272
  • Fax: 253-426-4060
Mailing address:
  • Phone: 253-426-6272
  • Fax: 253-426-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29874
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number29874
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberT8816
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61441574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: