Individual
FORREST GIRDLEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
621 SCIENCE DR, MADISON, WI 53711
(608) 265-8303
Mailing address
8007 EXCELSIOR DR, MADISON, WI 53717
(608) 829-5247
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
243
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42932400
—
WI
Enumeration date
04/17/2006
Last updated
07/08/2007
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