Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1836 | MN |
NPI | 1164502175 |
---|---|
Provider Name | Dr. Gregory Charles Fors |
First Address | Mora, MN 55051-7714 |
Second Address | Minnetonka, MN 55305-2366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |