MEDICARE: DANA M FORTE DO

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	649	NV

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	:	1558343772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA M FORTE DO

Provider Business Mailing Address
First Line	:	9010 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8932
Country	:	US
Telephone Number	:	702-240-8646
Fax Number	:	702-240-0206

Provider Business Practice Location Address
First Line	:	9010 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8932
Country	:	US
Telephone Number	:	702-240-8646
Fax Number	:	702-240-0206

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	11/18/2014

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Directions to “ DANA M FORTE DO” Practice Location

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