Forest, Jack L

Forest, Jack L is an individual health care provider with primary practice located at 2016 S Main St , Maryville MO 64468-2655. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Forest, Jack L can be contacted via phone (660) 562-2600.

Contact Information

Primary practice address
2016 S Main St Maryville MO 64468-2655
Phone: (660) 562-2600
Fax: (660) 562-7911
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 049972 Virginia

Profile Details

NPI number 1679560775
LBN Legal business name Forest, Jack L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2005
Last updated Jan 6th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679560775 NPPES
Virginia Other C09633 GROUP PTAN
Virginia MEDICAID 7313519 GROUP PTAN
Virginia Other C06695 GROUP PTAN

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