MEDICARE: G VAUGHN FORSYTH

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1700043924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	G VAUGHN FORSYTH

Provider Business Mailing Address
First Line	:	271 WATER ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4009
Country	:	US
Telephone Number	:	831-427-5290
Fax Number	:	831-459-6504

Provider Business Practice Location Address
First Line	:	271 WATER ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4009
Country	:	US
Telephone Number	:	831-427-5290
Fax Number	:	831-459-6504

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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Directions to “ G VAUGHN FORSYTH ” Practice Location

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