Provider Demographics
NPI:1912953993
Name:FOLLETT, FOREST (MD)
Entity Type:Individual
Prefix:DR
First Name:FOREST
Middle Name:
Last Name:FOLLETT
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:PO BOX 28916
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8916
Mailing Address - Country:US
Mailing Address - Phone:559-228-4298
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:48677 VICTORIA LN
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9216
Practice Address - Country:US
Practice Address - Phone:559-683-2992
Practice Address - Fax:559-224-3920
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39048207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A390480Medicaid
CAA39048OtherSTATE LICENSE
CAA28801Medicare UPIN
CA00A390483Medicare PIN