Provider Demographics
NPI:1467434936
Name:FORRISTER, SONJA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:LOUISE
Last Name:FORRISTER
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 E YOUNG ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-1344
Practice Address - Country:US
Practice Address - Phone:325-247-4131
Practice Address - Fax:325-248-2099
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112906101OtherFIRSTCARE
TX138830808Medicaid
TX138830804Medicaid
TX92070OtherSCOTT & WHITE
TX83017KOtherBCBS
TX8981K7Medicare PIN
TXTXB127417Medicare PIN
TX8398K8Medicare PIN
TX138830804Medicaid