MEDICARE: DR. TERI DENISE FORNEY 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	207V00000X	Obstetrics & Gynecology Physician	Q0437	TX

General Provider Information

NPI Number	:	1659682664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERI DENISE FORNEY M.D.

Provider Business Mailing Address
First Line	:	1505 W JEFFERSON ST
Second Line	:	SUITE 120
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-2277
Country	:	US
Telephone Number	:	972-938-3493
Fax Number	:	972-937-5608

Provider Business Practice Location Address
First Line	:	1505 W JEFFERSON ST
Second Line	:	SUITE 120
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-2277
Country	:	US
Telephone Number	:	972-938-3493
Fax Number	:	972-937-5608

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	11/18/2014

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