MEDICARE: DR. SHANON ALEX FORSETER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	2002023834	MO
2	207V00000X	Obstetrics & Gynecology Physician	60580	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033125935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANON ALEX FORSETER MD

Provider Business Mailing Address
First Line	:	5314 STONEYBROOK DR
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-6167
Country	:	US
Telephone Number	:	314-757-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 N HIGH ST STE 230
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5507
Country	:	US
Telephone Number	:	303-200-1131
Fax Number	:	303-839-7761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	06/19/2020

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