MEDICARE: DR. STEPHEN DAVID FORNER 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	2084N0400X	Neurology Physician	G35751	CA

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	:	1336141159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN DAVID FORNER MD

Provider Business Mailing 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

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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