Provider Demographics
NPI:1346900537
Name:FORSYTH, DARRIN N (CEP)
Entity Type:Individual
Prefix:MR
First Name:DARRIN
Middle Name:N
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85193-5600
Mailing Address - Country:US
Mailing Address - Phone:520-342-8361
Mailing Address - Fax:
Practice Address - Street 1:371 S. THORNTON ROAD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85193-8512
Practice Address - Country:US
Practice Address - Phone:520-342-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZP000064065207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty