Provider Demographics
NPI:1316145774
Name:STEPHEN D. FORNER, M.D. MEDICAL CORPORATION
Entity type:Organization
Organization Name:STEPHEN D. FORNER, M.D. MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-894-3330
Mailing Address - Street 1:1405 MAGNOLIA AVE
Mailing Address - Street 2:STE B
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3226
Mailing Address - Country:US
Mailing Address - Phone:530-894-3330
Mailing Address - Fax:530-894-1770
Practice Address - Street 1:1405 MAGNOLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3226
Practice Address - Country:US
Practice Address - Phone:530-894-3330
Practice Address - Fax:530-894-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0357512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336141159OtherNPI TYPE 1
CA1336141159OtherNPI TYPE 1
CAA46468Medicare UPIN