Provider Demographics
NPI:1124065222
Name:FORREST, DARRON E (PA)
Entity type:Individual
Prefix:
First Name:DARRON
Middle Name:E
Last Name:FORREST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 WINTON M BLOUNT LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3507
Mailing Address - Country:US
Mailing Address - Phone:334-280-1500
Mailing Address - Fax:334-280-1611
Practice Address - Street 1:273 WINTON M BLOUNT LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3507
Practice Address - Country:US
Practice Address - Phone:334-280-1500
Practice Address - Fax:334-280-1611
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.16363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPA-16OtherPHYSICIAN ASSISTANT
AL102I979087Medicare PIN