MEDICARE: DR. BRIAN RAY FORREST M.D.

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	207Q00000X	Family Medicine Physician	200000420	NC

General Provider Information

NPI Number	:	1376540112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN RAY FORREST M.D.

Provider Business Mailing Address
First Line	:	1031 W WILLIAMS ST
Second Line	:	SUITE 106
City	:	APEX
State	:	NC
Zip	:	27502-3955
Country	:	US
Telephone Number	:	919-363-0190
Fax Number	:	919-363-0195

Provider Business Practice Location Address
First Line	:	1031 W WILLIAMS ST
Second Line	:	SUITE 106
City	:	APEX
State	:	NC
Zip	:	27502-3955
Country	:	US
Telephone Number	:	919-363-0190
Fax Number	:	919-363-0195

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/08/2011

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