Provider Demographics
NPI:1598859829
Name:FORSTER, CHARLES
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:FORSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-3534
Mailing Address - Country:US
Mailing Address - Phone:509-248-3334
Mailing Address - Fax:509-453-6144
Practice Address - Street 1:602 E NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-3534
Practice Address - Country:US
Practice Address - Phone:509-248-3334
Practice Address - Fax:509-453-6144
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8141830Medicaid
WA8141830OtherCHPW
WAFO6451OtherREGENCE
3812OtherGROUP HEALTH
911019392OtherCOMMERCIAL
WA7541OtherL & I
WAFO6451OtherREGENCE
911019392OtherCOMMERCIAL
3812OtherGROUP HEALTH