Provider Demographics
NPI:1265435622
Name:FORSYTHE, SARAH EP (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:EP
Last Name:FORSYTHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:EP
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6233 MCFARLAND RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9475
Mailing Address - Country:US
Mailing Address - Phone:209-423-1093
Mailing Address - Fax:
Practice Address - Street 1:6233 MCFARLAND RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-9475
Practice Address - Country:US
Practice Address - Phone:209-423-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI18500Medicare UPIN
ILK11084Medicare ID - Type Unspecified