Healthcare Provider Details

I. General information

NPI: 1447475652
Provider Name (Legal Business Name): JULIE LARKIN FOREMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ELIZABETH LARKIN M.D

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 RUE LOUIS XIV STE A
LAFAYETTE LA
70508-5736
US

IV. Provider business mailing address

203 RUE LOUIS XIV STE A
LAFAYETTE LA
70508-5736
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2393
  • Fax: 337-981-9470
Mailing address:
  • Phone: 337-981-2393
  • Fax: 337-981-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number204569
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD.204569
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: