Basic Information
Provider Information
NPI: 1932178621
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FORSTER
FirstName: GARY
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 720 OLIVE WAY
Address2:  
City: SEATTLE
State: WA
PostalCode: 981011874
CountryCode: US
TelephoneNumber: 2068382590
FaxNumber: 2062648689
Practice Location
Address1: 7320 216TH ST SW
Address2:  
City: EDMONDS
State: WA
PostalCode: 980268006
CountryCode: US
TelephoneNumber: 4256733900
FaxNumber: 4256733910
Other Information
ProviderEnumerationDate: 03/15/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XMD00018042WAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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