Provider Demographics
NPI:1144292921
Name:FORGASON, BURT LANIER (MD)
Entity type:Individual
Prefix:MR
First Name:BURT
Middle Name:LANIER
Last Name:FORGASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7517 BRIAR ROSE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1803
Mailing Address - Country:US
Mailing Address - Phone:713-784-5893
Mailing Address - Fax:
Practice Address - Street 1:14441 MEMORIAL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6744
Practice Address - Country:US
Practice Address - Phone:281-493-1230
Practice Address - Fax:281-493-3814
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B66KMedicare ID - Type Unspecified