Provider Demographics
NPI:1477643377
Name:FORSTER, WOLFRAM R (MD, FACR)
Entity Type:Individual
Prefix:DR
First Name:WOLFRAM
Middle Name:R
Last Name:FORSTER
Suffix:
Gender:M
Credentials:MD, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 CAMINITO HERMINIA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7221
Mailing Address - Country:US
Mailing Address - Phone:858-490-0086
Mailing Address - Fax:
Practice Address - Street 1:1855 1ST AVE
Practice Address - Street 2:STE. 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2685
Practice Address - Country:US
Practice Address - Phone:619-793-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 507652085R0202X
CAC50765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology