Provider Demographics
NPI:1063461036
Name:FORTE, THALIA B (MD)
Entity Type:Individual
Prefix:
First Name:THALIA
Middle Name:B
Last Name:FORTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 W 15TH ST
Mailing Address - Street 2:BLDG. C
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4737
Mailing Address - Country:US
Mailing Address - Phone:972-596-4033
Mailing Address - Fax:972-758-1163
Practice Address - Street 1:8401 JACK FINNEY BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-3017
Practice Address - Country:US
Practice Address - Phone:800-945-2455
Practice Address - Fax:903-453-2541
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ5574174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG16424Medicare UPIN
TX8D6187Medicare PIN
TXP00237401Medicare PIN
TX8D6186Medicare PIN