Provider Demographics
NPI:1720278252
Name:TENNANT, FOREST SEARLS JR (MD)
Entity type:Individual
Prefix:
First Name:FOREST
Middle Name:SEARLS
Last Name:TENNANT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:338 SO GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3043
Mailing Address - Country:US
Mailing Address - Phone:626-919-0064
Mailing Address - Fax:626-919-0065
Practice Address - Street 1:338 SO GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3043
Practice Address - Country:US
Practice Address - Phone:626-919-0064
Practice Address - Fax:626-919-0065
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A41407Medicare UPIN