Provider Demographics
NPI:1417070707
Name:BEATY, FORREST O (MD)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:O
Last Name:BEATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1427
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-1427
Mailing Address - Country:US
Mailing Address - Phone:707-887-7597
Mailing Address - Fax:707-887-7669
Practice Address - Street 1:6015 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:CA
Practice Address - Zip Code:95436-9629
Practice Address - Country:US
Practice Address - Phone:707-887-7597
Practice Address - Fax:707-887-7669
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA024751207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A247511Medicaid
CAA24114Medicare UPIN
CA00A247510Medicare ID - Type Unspecified