Healthcare Provider Details

I. General information

NPI: 1861554115
Provider Name (Legal Business Name): TRENT FOGLEMAN, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 BERTRAND DR. SUITE D
LAFAYETTE LA
70506
US

IV. Provider business mailing address

1817 BERTRAND DR. SUITE D
LAFAYETTE LA
70506
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-7790
  • Fax: 337-443-9220
Mailing address:
  • Phone: 337-456-7790
  • Fax: 337-443-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADDIE F LAVIOLETTE
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 337-456-7790