Provider Demographics
NPI:1487092797
Name:FORREST, BRENT DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DANIEL
Last Name:FORREST
Suffix:
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 1:23401 PRAIRIE STAR PKWY STE B-300
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-7268
Mailing Address - Country:US
Mailing Address - Phone:913-677-6319
Mailing Address - Fax:660-687-1148
Practice Address - Street 1:23401 PRAIRIE STAR PKWY STE B-300
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7268
Practice Address - Country:US
Practice Address - Phone:913-677-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-08
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
KS0445968208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No171000000XOther Service ProvidersMilitary Health Care Provider