Provider Demographics
NPI:1609182377
Name:SEXTON, FOREST RAY (CPO)
Entity Type:Individual
Prefix:
First Name:FOREST
Middle Name:RAY
Last Name:SEXTON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 CRATER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6242
Mailing Address - Country:US
Mailing Address - Phone:541-734-2435
Mailing Address - Fax:541-734-4366
Practice Address - Street 1:1180 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6242
Practice Address - Country:US
Practice Address - Phone:541-734-2435
Practice Address - Fax:541-734-4366
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist