Provider Demographics
NPI:1326047457
Name:FORSYTHE, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:FORSYTHE
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 1:2300 HIGHWAY 365 STE 230
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6283
Mailing Address - Country:US
Mailing Address - Phone:409-722-0808
Mailing Address - Fax:409-722-4422
Practice Address - Street 1:2300 HIGHWAY 365 STE 230
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6283
Practice Address - Country:US
Practice Address - Phone:409-722-0808
Practice Address - Fax:409-722-4422
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9635208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1264582-07Medicaid
TX8AJ013OtherBCBS INDIVIDUAL PROVIDER#
TXP00382814OtherRAILROAD MEDICARE INDIVIDUAL PROVIDER #
TX8F3051OtherMEDICARE PROVIDER #
TX8F3051OtherMEDICARE PROVIDER #
TXP00382814OtherRAILROAD MEDICARE INDIVIDUAL PROVIDER #