Provider Demographics
NPI:1841321528
Name:FORREST, PETER EUGENE CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:EUGENE CHRISTIAN
Last Name:FORREST
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:RR 1 BOX 360
Mailing Address - Street 2:181 BEECH GROVE DRIVE
Mailing Address - City:BURKEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75932-9733
Mailing Address - Country:US
Mailing Address - Phone:409-565-4246
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 360
Practice Address - Street 2:181 BEECH GROVE DRIVE
Practice Address - City:BURKEVILLE
Practice Address - State:TX
Practice Address - Zip Code:75932-9733
Practice Address - Country:US
Practice Address - Phone:409-565-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5541207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8246B7Medicare PIN
TXB 22757Medicare UPIN
TX00BV10Medicare ID - Type Unspecified