Provider Demographics
NPI:1457393902
Name:FORSYTH, ASHLEY W (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:W
Last Name:FORSYTH
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 1:1211 SW BAY ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4843
Mailing Address - Country:US
Mailing Address - Phone:541-270-7146
Mailing Address - Fax:
Practice Address - Street 1:1211 SW BAY ST
Practice Address - Street 2:UNIT B
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4843
Practice Address - Country:US
Practice Address - Phone:541-270-7146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO14953207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE41467Medicare UPIN