Provider Demographics
NPI:1144251711
Name:FORBES, CAROLYN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:FORBES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 N 400 E
Mailing Address - Street 2:STE 102
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3413
Mailing Address - Country:US
Mailing Address - Phone:435-843-1225
Mailing Address - Fax:435-843-1228
Practice Address - Street 1:2376 N 400 E
Practice Address - Street 2:STE 102
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3413
Practice Address - Country:US
Practice Address - Phone:435-843-1225
Practice Address - Fax:435-843-1228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT346411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG52672Medicare UPIN
UT000011923Medicare PIN
UT000011923Medicare PIN