Provider Demographics
NPI:1548289911
Name:FORESMAN, GARY EDMOND (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:EDMOND
Last Name:FORESMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:180 WEST LE POINT ST.
Mailing Address - Street 2:UNIT A
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-481-3442
Mailing Address - Fax:805-481-3443
Practice Address - Street 1:180 WEST LE POINT ST.
Practice Address - Street 2:UNIT A
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-481-3442
Practice Address - Fax:805-481-3442
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110245015OtherRAILROAD MEDICARE PIN
110245015OtherRAILROAD MEDICARE PIN