Provider Demographics
NPI:1184013187
Name:FORBANG, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FORBANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 DESEO APT 1087
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3182
Mailing Address - Country:US
Mailing Address - Phone:813-793-1836
Mailing Address - Fax:
Practice Address - Street 1:6515 DESEO APT 1087
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3182
Practice Address - Country:US
Practice Address - Phone:813-793-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist