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General NPI Number Information
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NPI Number | 1104124007
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Entity Type | Individual
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Provider Name | BRANDON HOWARD FORESTER P.A.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1111 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85006-2612
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Country | US
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Telephone | 602-839-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 21531 N 61ST ST
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City | PHOENIX
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State | AZ
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Zip | 85054-5813
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Country | US
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Telephone | 480-385-8583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 56001005935
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5079
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License Number State | AZ
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