Lawrence P Forman III, R.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

471 Issued in NM

Practice address

US Highway 491 North
Shiprock, NM 87420-0160

Phone

(505) 368-6204

Fax

(505) 368-6265

NPI assigned

Jul 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Larry P Forman Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218672000000",
    "number": "1174553515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874200160",
            "telephone_number": "505-368-6401",
            "fax_number": "505-368-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HIGHWAY 491 NORTH",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874200160",
            "telephone_number": "505-368-6204",
            "fax_number": "505-368-6265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "LAWRENCE",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "R.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2008-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NM",
            "license": "471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G2352",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230062",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARRY",
            "last_name": "FORMAN",
            "middle_name": "P",
            "credential": "R.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Omar Fares, MD
• Mary G. Felty, RN
• Kathryn L Fick, MD
• Alyssa M Finlay, MD
• Carol Flute, LPN
• Andrew Michael Foster, PHARM.D.
• Venecia Rashonda Foster, LMSW
• Four Brothers Health Care,LLC
• Four Corners HHC
• Four Seasons Home Health Care

• Registered Dietitian in Shiprock, NM
• Providers in Shiprock, NM by specialty
• Registered Dietitian in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.