Provider Demographics
NPI:1285660944
Name:FORREST, TERRY L (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:FORREST
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 1:2426 LEE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-5967
Mailing Address - Country:US
Mailing Address - Phone:276-591-1125
Mailing Address - Fax:
Practice Address - Street 1:2426 LEE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5967
Practice Address - Country:US
Practice Address - Phone:276-591-1125
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055415174400000X
TNMD28939174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA183130OtherANTHEM BCBS
4411600OtherAETNA
TN4111176OtherBCBS
TN0101OtherJOHN DEERE INSURANCE CO
TN0101OtherJOHN DEERE INSURANCE CO