Provider Demographics
NPI:1336242403
Name:FORBES, CRAIG WALLACE (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WALLACE
Last Name:FORBES
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 1:1487 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8496
Mailing Address - Country:US
Mailing Address - Phone:937-393-3406
Mailing Address - Fax:
Practice Address - Street 1:1487 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8496
Practice Address - Country:US
Practice Address - Phone:937-393-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46820207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201242060Medicaid
KY7100284700Medicaid
F47291Medicare UPIN
IN201242060Medicaid