Provider Demographics
NPI:1619983178
Name:FORSYTHE, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FORSYTHE
Suffix:
Gender:M
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 21015
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89515-1015
Mailing Address - Country:US
Mailing Address - Phone:775-827-0707
Mailing Address - Fax:775-827-1006
Practice Address - Street 1:521 HAMMILL LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1004
Practice Address - Country:US
Practice Address - Phone:775-827-0707
Practice Address - Fax:775-827-1006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-06-05
Deactivation Date:2009-05-22
Deactivation Code:
Reactivation Date:2009-06-05
Provider Licenses
StateLicense IDTaxonomies
NV2864207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAY5657OtherHEALTHNET
NV002016139Medicaid
NVCC2864OtherANTHEM
NV002016139Medicaid