Healthcare Provider Details

I. General information

NPI: 1265492714
Provider Name (Legal Business Name): GERALD L FORET JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA ST
BOGALUSA LA
70427-3729
US

IV. Provider business mailing address

3311 PRESCOTT RD SUITE 417
ALEXANDRIA LA
71301-3900
US

V. Phone/Fax

Practice location:
  • Phone: 985-730-6700
  • Fax: 985-730-6713
Mailing address:
  • Phone: 318-704-6389
  • Fax: 318-704-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD.018213
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: