MEDICARE: MICHAEL J FORREST P.A.

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	363A00000X	Physician Assistant	PA639	NV
2	363A00000X	Physician Assistant	PA01460	OR

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	:	1669432662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J FORREST P.A.

Provider Business Mailing Address
First Line	:	PO BOX 3397
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3397
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 S WAHANNA RD
Second Line	:
City	:	SEASIDE
State	:	OR
Zip	:	97138-7735
Country	:	US
Telephone Number	:	503-717-7000
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	09/25/2020

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