MEDICARE: JENNIFER FORAN 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	2084P0800X	Psychiatry Physician	30617	AZ
2	2084P0800X	Psychiatry Physician	036.102122	IL

General Provider Information

NPI Number	:	1639304199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FORAN M.D.

Provider Business Mailing Address
First Line	:	105 N 5TH AVE
Second Line	:
City	:	HOLBROOK
State	:	AZ
Zip	:	86025-2817
Country	:	US
Telephone Number	:	928-524-2853
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 N 5TH AVE
Second Line	:
City	:	HOLBROOK
State	:	AZ
Zip	:	86025-2817
Country	:	US
Telephone Number	:	928-524-2853
Fax Number	:

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/27/2009

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Directions to “ JENNIFER FORAN M.D.” Practice Location

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