Provider Demographics
NPI:1376540112
Name:FORREST, BRIAN RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RAY
Last Name:FORREST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1031 W WILLIAMS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3955
Mailing Address - Country:US
Mailing Address - Phone:919-363-0190
Mailing Address - Fax:919-363-0195
Practice Address - Street 1:1031 W WILLIAMS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3955
Practice Address - Country:US
Practice Address - Phone:919-363-0190
Practice Address - Fax:919-363-0195
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200000420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI28740Medicare UPIN