Provider Demographics
NPI:1619904273
Name:FORESTER, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:FORESTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1700 MCHENRY VILLAGE WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4341
Mailing Address - Country:US
Mailing Address - Phone:209-549-1057
Mailing Address - Fax:209-549-9827
Practice Address - Street 1:1700 MCHENRY VILLAGE WAY STE 2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4341
Practice Address - Country:US
Practice Address - Phone:209-549-1057
Practice Address - Fax:209-549-9827
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG60869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
38-3681072OtherPRACTICE FEDERAL TAX ID
E29232Medicare UPIN