Provider Demographics
NPI:1114116274
Name:FORUM FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:FORUM FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TORMOHLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-996-1020
Mailing Address - Street 1:14001 E ILIFF AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1405
Mailing Address - Country:US
Mailing Address - Phone:303-996-1020
Mailing Address - Fax:303-751-4514
Practice Address - Street 1:14001 E ILIFF AVE
Practice Address - Street 2:STE 109
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1405
Practice Address - Country:US
Practice Address - Phone:303-996-1020
Practice Address - Fax:303-751-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty