Provider Demographics
NPI:1053488288
Name:FORESTER, JONATHAN S (MD MS)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:S
Last Name:FORESTER
Suffix:
Gender:M
Credentials:MD MS
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Mailing Address - Street 1:2809 DONAHUE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-641-0865
Mailing Address - Fax:318-640-3290
Practice Address - Street 1:2809 DONAHUE FERRY RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-641-0865
Practice Address - Fax:318-640-3290
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA06029R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA51165Medicare ID - Type Unspecified
B62849Medicare UPIN