Provider Demographics
NPI:1417994369
Name:FORSETH, LORI (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FORSETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-2119
Mailing Address - Country:US
Mailing Address - Phone:406-628-6311
Mailing Address - Fax:406-328-2830
Practice Address - Street 1:1035 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-2119
Practice Address - Country:US
Practice Address - Phone:406-628-6311
Practice Address - Fax:406-328-2830
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine