MEDICARE: STEPHEN D. FORNER, M.D. MEDICAL CORPORATION

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	2084N0400X	Neurology Physician	G035751	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336141159	OTHER	CA	NPI TYPE 1

General Provider Information

NPI Number	:	1316145774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN D. FORNER, M.D. MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1405 MAGNOLIA AVE
Second Line	:	STE B
City	:	CHICO
State	:	CA
Zip	:	95926-3226
Country	:	US
Telephone Number	:	530-894-3330
Fax Number	:	530-894-1770

Provider Business Practice Location Address
First Line	:	1405 MAGNOLIA AVE
Second Line	:	SUITE B
City	:	CHICO
State	:	CA
Zip	:	95926-3226
Country	:	US
Telephone Number	:	530-894-3330
Fax Number	:	530-894-1770

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. BONNIE L. SMITH
Credential	:
Telephone Number	:	530-894-3330

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	08/22/2020

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