Organization
KEVIN FORSYTHE MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN C FORSYTHE MD (PRESIDENT)
(805) 952-5723
Entity
Organization
Contact information
Practice address
1111 LAS TABLAS ROAD SUITE R, TEMPLETON, CA 93465-3742
(805) 286-4416
(888) 216-9538
Mailing address
1111 LAS TABLAS ROAD SUITE R, TEMPLETON, CA 93465-3742
(805) 286-4416
(888) 216-9538
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A96098
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10507
CITY OF PASO ROBLES BUSINESS LICENSE
CA
01
—
C3375536
SECRETARY OF STATE CORPORATION NUMBER
CA
Enumeration date
06/16/2011
Last updated
07/21/2022
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