MEDICARE: PHILIP CHRISTOPHER FORNO 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	2086S0105X	Surgery of the Hand (Surgery) Physician	MD2009-0150	NM
2	207X00000X	Orthopaedic Surgery Physician	MD2009-0150	NM

General Provider Information

NPI Number	:	1912038449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP CHRISTOPHER FORNO M.D.

Provider Business Mailing Address
First Line	:	2100 CALLE DE LA VUELTA
Second Line	:	SUTIE C103
City	:	SANTA FE
State	:	NM
Zip	:	87505-4742
Country	:	US
Telephone Number	:	505-982-5014
Fax Number	:	505-982-2687

Provider Business Practice Location Address
First Line	:	2100 CALLE DE LA VUELTA
Second Line	:	SUTIE C103
City	:	SANTA FE
State	:	NM
Zip	:	87505-4742
Country	:	US
Telephone Number	:	505-982-5014
Fax Number	:	505-982-2687

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	01/17/2013

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