Provider Demographics
NPI:1780005397
Name:FORTE, JEAN-MARCEL (PA)
Entity type:Individual
Prefix:MR
First Name:JEAN-MARCEL
Middle Name:
Last Name:FORTE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:DR
Other - First Name:ALPHONSE
Other - Middle Name:G
Other - Last Name:DUFRENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3453 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6913
Mailing Address - Country:US
Mailing Address - Phone:305-807-4283
Mailing Address - Fax:954-337-0319
Practice Address - Street 1:1736 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-5721
Practice Address - Country:US
Practice Address - Phone:954-267-9696
Practice Address - Fax:954-337-0319
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107457207Q00000X
FLPA 9107467363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine