Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 20770 | AZ |
Y | 207RC0000X | Internist - Cardiovascular Disease | E-6499 | AR |
NPI | 1003887589 |
---|---|
Provider Name | Joseph Wayne Forney SR. |
First Address | Little Rock, AR 72211-3886 |
Second Address | Little Rock, AR 72211-3886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 19/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00882 | RR MEDICARE (01) | AZ |
123711 | (05) | AZ |
200691531 | TAX ID (01) | AZ |
A12989 | (02) | AZ |
AZ0747910 | BCBS ID (01) | AZ |
CH003 | TRICARE (01) | AZ |