MEDICARE: MR. DARRIN N FORSYTH CEP

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	P000064065	AZ

General Provider Information

NPI Number	:	1346900537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRIN N FORSYTH CEP

Provider Business Mailing Address
First Line	:	317 S THORNTON RD
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85193-5600
Country	:	US
Telephone Number	:	520-342-8361
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 S. THORNTON ROAD
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85193-8512
Country	:	US
Telephone Number	:	520-342-8361
Fax Number	:

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

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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