MEDICARE: DR. FORREST C. HASLUP 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	208600000X	Surgery Physician	ME40892	FL

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	:	1336142736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FORREST C. HASLUP MD

Provider Business Mailing Address
First Line	:	PO BOX 10744
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33757-8744
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:	727-266-4928

Provider Business Practice Location Address
First Line	:	4211 VANDYKE ROAD
Second Line	:	SUITE 200
City	:	LUTZ
State	:	FL
Zip	:	33558-8004
Country	:	US
Telephone Number	:	813-264-6490
Fax Number	:	813-321-1878

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/18/2015

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