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General NPI Number Information
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NPI Number | 1912127994
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Entity Type | Organization
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Legal Business Name | JAMES R FORSTNER
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 4654 LONG BEACH RD SE
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City | SOUTHPORT
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State | NC
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Zip | 28461-8799
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Country | US
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Telephone | 910-457-9564
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Fax | 910-457-6744
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Provider Business Mailing Address
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Address Line | 4654 LONG BEACH RD SE
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City | SOUTHPORT
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State | NC
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Zip | 28461-8799
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Country | US
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Telephone | 910-457-9564
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Fax | 910-457-6744
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES R FORSTNER
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Credential | M.D.
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Telephone | 910-457-9564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 21467
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License Number State | NC
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