Individual
FORREST D GORTER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 747-4577
Mailing address
150 S 12TH ST, PHOENIX, AZ 85034-2301
(602) 495-5797
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1023
AZ
Other
Enumeration date
05/28/2006
Last updated
07/08/2007
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