Provider Demographics
NPI:1700043924
Name:FORSYTH, G VAUGHN
Entity Type:Individual
Prefix:
First Name:G VAUGHN
Middle Name:
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GORDON
Other - Middle Name:VAUGHN
Other - Last Name:FORSYTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:271 WATER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4009
Mailing Address - Country:US
Mailing Address - Phone:831-427-5290
Mailing Address - Fax:831-459-6504
Practice Address - Street 1:271 WATER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4009
Practice Address - Country:US
Practice Address - Phone:831-427-5290
Practice Address - Fax:831-459-6504
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other