Provider Demographics
NPI:1982643565
Name:FORSYTHE, WILLIAM CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N MORAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2667
Mailing Address - Country:US
Mailing Address - Phone:509-735-6900
Mailing Address - Fax:509-735-6914
Practice Address - Street 1:415 N MORAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2667
Practice Address - Country:US
Practice Address - Phone:509-735-6900
Practice Address - Fax:509-735-6914
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001658207Q00000X, 207RG0300X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202686OtherLIWA
WA8246290Medicaid
WA3075FOOtherBSWA
WA930079500Medicare PIN
WA3075FOOtherBSWA
WA8246290Medicaid
WAG8856293Medicare PIN
WAP00296174Medicare PIN