Provider Demographics
NPI:1932166907
Name:FORKOS, EDWARD HENRY II (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:HENRY
Last Name:FORKOS
Suffix:II
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 1:10585 SOPRA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4180 S RAINBOW BLVD
Practice Address - Street 2:SUITE810
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3160
Practice Address - Country:US
Practice Address - Phone:702-383-3645
Practice Address - Fax:702-227-8429
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C38727Medicare UPIN