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General NPI Number Information
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NPI Number | 1740272632
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Entity Type | Individual
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Provider Name | MARTIN THOMAS FORREST D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 620 S SANDLAKE CT
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City | MOUNT DORA
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State | FL
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Zip | 32757-6084
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Country | US
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Telephone | 443-521-5654
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Fax | 888-727-2212
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Provider Business Mailing Address
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Address Line | 620 S SANDLAKE CT
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City | MOUNT DORA
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State | FL
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Zip | 32757-6084
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Country | US
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Telephone | 443-521-5654
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Fax | 888-727-2212
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | H0060785
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | DO2292
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License Number State | ME
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