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General NPI Number Information
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NPI Number | 1255661732
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Entity Type | Organization
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Legal Business Name | LEE A FORESTIERE MD PA
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 1609 W 40TH AVE STE 403
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City | PINE BLUFF
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State | AR
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Zip | 71603-6365
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Country | US
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Telephone | 870-534-4188
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Fax | 870-534-7964
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Provider Business Mailing Address
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Address Line | 1609 W 40TH AVE STE 403
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City | PINE BLUFF
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State | AR
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Zip | 71603-6365
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Country | US
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Telephone | 870-534-4188
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Fax | 870-534-7964
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RENEE BOGY
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Credential |
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Telephone | 870-534-4188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C4813
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License Number State | AR
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