Provider Demographics
NPI:1285674671
Name:FORSHA, DOUGLASS WILLIAM (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLASS
Middle Name:WILLIAM
Last Name:FORSHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10654 SOUTH RIVER HEIGHTS DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-569-1456
Mailing Address - Fax:801-565-7931
Practice Address - Street 1:10654 SOUTH RIVER HEIGHTS DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-569-1456
Practice Address - Fax:801-565-7931
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1850911205173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000010103Medicare ID - Type Unspecified
UTD13612Medicare UPIN