Provider Demographics
NPI:1407808538
Name:FORBES, GARY C (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:C
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 1:934 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2957
Mailing Address - Country:US
Mailing Address - Phone:360-385-5330
Mailing Address - Fax:360-385-0206
Practice Address - Street 1:934 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2957
Practice Address - Country:US
Practice Address - Phone:360-385-5330
Practice Address - Fax:360-385-0206
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8240145Medicaid
WAAB07216OtherMEDICARE RHC
WA8240145Medicaid
WAF96981Medicare UPIN