Provider Demographics
NPI:1396783726
Name:FORSLUND, DARREL RICHARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:DARREL
Middle Name:RICHARD
Last Name:FORSLUND
Suffix:JR
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 1:1915 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3006
Mailing Address - Country:US
Mailing Address - Phone:712-262-5479
Mailing Address - Fax:
Practice Address - Street 1:1915 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3006
Practice Address - Country:US
Practice Address - Phone:712-262-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0061273207Q00000X
IA27694207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4057745Medicaid
IA4057745Medicaid
IAE69705Medicare UPIN