Provider Demographics
NPI:1215965058
Name:FORSTER, EDWARD H (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:H
Last Name:FORSTER
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 1:1301 HODGES DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4614
Mailing Address - Country:US
Mailing Address - Phone:850-431-5714
Mailing Address - Fax:850-431-6403
Practice Address - Street 1:1301 HODGES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4614
Practice Address - Country:US
Practice Address - Phone:850-431-5714
Practice Address - Fax:850-431-6403
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376168100Medicaid
FL0661650001Medicare NSC
FL376168100Medicaid
25945XMedicare PIN
F89987Medicare UPIN