Provider Demographics
NPI:1912951179
Name:JOHN L. FORSYTHE, M.D.P.A
Entity type:Organization
Organization Name:JOHN L. FORSYTHE, M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORSYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-749-7130
Mailing Address - Street 1:2300 HIGHWAY 365 STE 230
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6283
Mailing Address - Country:US
Mailing Address - Phone:409-722-0808
Mailing Address - Fax:409-722-4422
Practice Address - Street 1:2300 HIGHWAY 365 STE 230
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6283
Practice Address - Country:US
Practice Address - Phone:409-722-0808
Practice Address - Fax:409-722-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W540OtherMEDICARE PROVIDER #
TX1839607-01Medicaid
TX0141PUOtherBCBS GROUP PROVIDER #
TXDF6603OtherRAILROAD MEDICARE
TX0141PUOtherBCBS GROUP PROVIDER #
TX00W540OtherMEDICARE PROVIDER #