Provider Demographics
NPI:1942397005
Name:TIMOTHY J FORNESS MDPA
Entity Type:Organization
Organization Name:TIMOTHY J FORNESS MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-285-3427
Mailing Address - Street 1:2655 S BAYSHORE DR APT 514
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5416
Mailing Address - Country:US
Mailing Address - Phone:305-285-3427
Mailing Address - Fax:305-285-3427
Practice Address - Street 1:2655 S BAYSHORE DR APT 514
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5416
Practice Address - Country:US
Practice Address - Phone:305-285-3427
Practice Address - Fax:305-285-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71975207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41365AMedicare ID - Type Unspecified
G29203Medicare UPIN