Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G71209 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G71209 | CA |
NPI | 1306881842 |
---|---|
Provider Name | Scott Kevin Forman |
First Address | Newport Beach, CA 92660-7853 |
Second Address | Newport Beach, CA 92660-7853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F31830 | (02) | CA |