Provider Demographics
NPI:1285863878
Name:FORBES, JOAQUIN MAURICIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:MAURICIO
Last Name:FORBES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 WESTSIDE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3085
Mailing Address - Country:US
Mailing Address - Phone:580-931-3636
Mailing Address - Fax:580-931-9016
Practice Address - Street 1:1201 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-1639
Practice Address - Country:US
Practice Address - Phone:580-889-1981
Practice Address - Fax:580-889-4009
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121432207Q00000X
OK30475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine