MEDICARE: MR. DAVID WAYNE FORNOF JR. PARAMEDIC

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	146L00000X	Paramedic	AZ00013221	AZ

General Provider Information

NPI Number	:	1437004413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID WAYNE FORNOF JR. PARAMEDIC

Provider Business Mailing Address
First Line	:	2648 S ARABY RD
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-7236
Country	:	US
Telephone Number	:	928-877-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2648 S ARABY RD
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-7236
Country	:	US
Telephone Number	:	928-877-0400
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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