Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | C34967 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | C34967 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | C34967 | CA |
NPI | 1144225897 |
---|---|
Provider Name | Walter A Forred |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93701-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2005 |
Last Update Date | 02/03/2017 |