MEDICARE: VIKI A. FORLANO 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	207Q00000X	Family Medicine Physician	H6647	TX

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	:	1376547216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKI A. FORLANO MD

Provider Business Mailing Address
First Line	:	PO BOX 22000
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-7200
Country	:	US
Telephone Number	:	325-481-2197
Fax Number	:	325-659-0180

Provider Business Practice Location Address
First Line	:	4235 SUNSET DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5653
Country	:	US
Telephone Number	:	325-481-2197
Fax Number	:	325-659-0180

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/29/2015

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