Individual
GRANT LEROY FORRESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 HOSPITAL DR, MAQUOKETA, IA 52060-1201
(563) 652-2474
Mailing address
2088 HAWTHORNE DR, PELLA, IA 50219-7914
(785) 313-5694
(785) 565-4754
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
30745
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002319
MEDICARE PTAN
KS
05
—
100644460F
—
KS
Enumeration date
06/23/2006
Last updated
04/05/2021
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