Individual
JOSEPH WAYNE FORNEY SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7 SHACKLEFORD WEST BLVD, LITTLE ROCK, AR 72211-3886
(501) 614-3606
(501) 663-5017
Mailing address
7 SHACKLEFORD WEST BLVD, LITTLE ROCK, AR 72211-3886
(501) 614-3606
(501) 663-5017
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
20770
AZ
207RC0000X
Cardiovascular Disease Physician
Primary
E-6499
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00882
RR MEDICARE
AZ
05
—
123711
—
AZ
01
—
200691531
TAX ID
AZ
01
—
AZ0747910
BCBS ID
AZ
01
—
CH003
TRICARE
AZ
Enumeration date
01/31/2006
Last updated
11/19/2013
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