Individual
MICHAEL J FORREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
725 S WAHANNA RD, SEASIDE, OR 97138-7735
(503) 717-7000
Mailing address
PO BOX 3397, PORTLAND, OR 97208-3397
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01460
OR
363A00000X
Physician Assistant
PA639
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100504788
—
NV
Enumeration date
03/24/2006
Last updated
09/25/2020
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