Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME71975 | FL |
NPI | 1437520509 |
---|---|
Provider Name | Timothy Joseeph Forness |
First Address | Palm Beach Gardens, FL 33410-4755 |
Second Address | Palm Beach Gardens, FL 33410-4755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2015 |
Last Update Date | 14/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
253487800 | (05) | FL |
G29203 | (02) | FL |