Individual
NATHAN BENJAMIN FORREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6901 MEDICAL PKWY, RADIOLOGY DEPARTMENT, WACO, TX 76712-7910
(254) 751-4000
(903) 663-7394
Mailing address
4777 US HIGHWAY 259, LONGVIEW, TX 75605-7668
(903) 663-7393
(903) 663-7394
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K3576
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1046328-04
CSHCN
TX
05
—
1046328-05
—
TX
01
—
8P1488
BLUE SHIELD
TX
01
—
8W7435
BLUE CROSS BLUE SHIELD
—
01
—
P00195387
RR/MEDICARE
TX
Enumeration date
03/28/2006
Last updated
04/15/2014
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