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Individual

JANIS SUZANN FORCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
7615 W THUNDERBIRD RD, STE 106, PEORIA, AZ 85381-6083
(623) 773-2273
(623) 773-2274
Mailing address
PO BOX 9609, BELFAST, ME 04915-9609
(623) 773-2273
(623) 773-2274

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1385
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
173336
AZ
Enumeration date
12/28/2005
Last updated
10/26/2012
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