Provider Demographics
NPI:1629251004
Name:FORSBERG, CLAY GARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:GARRETT
Last Name:FORSBERG
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 1:14275 N 87TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3696
Mailing Address - Country:US
Mailing Address - Phone:480-905-8485
Mailing Address - Fax:480-905-7274
Practice Address - Street 1:14275 N 87TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3696
Practice Address - Country:US
Practice Address - Phone:480-905-8485
Practice Address - Fax:480-905-7274
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48754208200000X, 2086S0122X
CAA1211632086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGJ636AMedicaid
CAGJ636AMedicaid