MEDICARE: LYNN EDWARD FORET M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	013222	LA
2	174400000X	Specialist	MD.013222	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205816642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN EDWARD FORET M.D.

Provider Business Mailing Address
First Line	:	640 DR. MICHAEL DEBAKEY DRIVE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-0000
Country	:	US
Telephone Number	:	337-562-1000
Fax Number	:	337-439-8829

Provider Business Practice Location Address
First Line	:	640 DR. MICHAEL DEBAKEY DRIVE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-0000
Country	:	US
Telephone Number	:	337-562-1000
Fax Number	:	337-439-8829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	12/06/2010

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