Provider Demographics
NPI:1952397440
Name:FORTE, JOSEPH W (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:FORTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1928
Mailing Address - Country:US
Mailing Address - Phone:334-793-5074
Mailing Address - Fax:334-699-5135
Practice Address - Street 1:210 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1928
Practice Address - Country:US
Practice Address - Phone:334-793-5074
Practice Address - Fax:334-699-5135
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143909003Medicaid
AL102I112358OtherMEDICARE PTIN
AR143909003Medicaid
AR5L904Medicare PIN
AL102I112358Medicare PIN
AR5L904Medicare ID - Type UnspecifiedMEDICARE PROVIDER