MEDICARE: DR. DONALD CHARLES FALGOUST MD

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	207W00000X	Ophthalmology Physician	MD12137R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5CT98	OTHER	LA	MEDICARE PTAN

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	:	1538168323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD CHARLES FALGOUST MD

Provider Business Mailing Address
First Line	:	PO BOX 4765
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70606-4765
Country	:	US
Telephone Number	:	337-477-0963
Fax Number	:	337-477-1912

Provider Business Practice Location Address
First Line	:	1980 TYBEE LANE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2400
Country	:	US
Telephone Number	:	337-479-0963
Fax Number	:	337-477-1912

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	02/02/2015

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