Provider Demographics
NPI:1740272632
Name:FORREST, MARTIN THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:THOMAS
Last Name:FORREST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S SANDLAKE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6084
Mailing Address - Country:US
Mailing Address - Phone:443-521-5654
Mailing Address - Fax:888-727-2212
Practice Address - Street 1:620 S SANDLAKE CT
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6084
Practice Address - Country:US
Practice Address - Phone:443-521-5654
Practice Address - Fax:888-727-2212
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0060785174400000X
MEDO2292207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No174400000XOther Service ProvidersSpecialist