David Wayne Forbis, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9101040 Issued in FL

Practice address

1715 Village Way
Orange Park, FL 32073-5263

Phone

(904) 264-8418

Fax

(904) 264-9692

NPI assigned

Dec 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1167436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932265097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 OHARA RD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320686857",
            "telephone_number": "904-276-3110",
            "fax_number": "904-264-9692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 VILLAGE WAY",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735263",
            "telephone_number": "904-264-8418",
            "fax_number": "904-264-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORBIS",
        "first_name": "DAVID",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9101040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPLOYER ID #",
            "identifier": "59-3629546",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark S Flynn, PSY.D
• Focused Wellness Clinic LLC
• Luther Scott Foley, LPTA
• Ana Maria Fonseca Cruz
• Anika C Forbes, D.O.
• Victoria D Ford, RN
• Andrew Forrest, DMD
• Hayley Forte
• Karen Lorfano Fouche, P.T.
• Foundation of the Personal Empowerment Center (FTPEC, Inc)

• Surgical Physician Assistant in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.