Active NPI
Forrest Benjamin Bethel, DO
- Surgery Physician
- Tucson, AZ
National Provider Identifier
1629767892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- R4022
- Practice address
- 1501 N Campbell Ave
Tucson, AZ 85724-0001 - Phone
- (520) 626-7747
- NPI assigned
- May 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | R4022 | AZ | Primary |
Addresses
Primary practice location
1501 N Campbell Ave
Tucson, AZ 85724-0001
Mailing address
4820 Tarantella LN
San Diego, CA 92130-2468
Phone (760) 887-4762
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R4022 | AZ | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690761600000",
"number": "1629767892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4820 TARANTELLA LN",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302468",
"telephone_number": "760-887-4762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 N CAMPBELL AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857240001",
"telephone_number": "520-626-7747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETHEL",
"first_name": "FORREST",
"middle_name": "BENJAMIN",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-03",
"last_updated": "2023-07-31",
"certification_date": "2023-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "R4022",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.