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Individual

FORREST R RITLAND

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1200 N BEAVER STREET, FLAGSTAFF, AZ 86001
(928) 773-2489
(928) 773-2283
Mailing address
1600 W UNIVERSITY AVE STE 215, FLAGSTAFF, AZ 86001-3115
(928) 774-1693
(928) 774-3533

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
16350
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
274671
AZ
01
AZ0255820
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
07/02/2006
Last updated
03/20/2015
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