Provider Demographics
NPI:1205816642
Name:FORET, LYNN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:EDWARD
Last Name:FORET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 DR. MICHAEL DEBAKEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-0000
Mailing Address - Country:US
Mailing Address - Phone:337-562-1000
Mailing Address - Fax:337-439-8829
Practice Address - Street 1:640 DR. MICHAEL DEBAKEY DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-0000
Practice Address - Country:US
Practice Address - Phone:337-562-1000
Practice Address - Fax:337-439-8829
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013222174400000X
LAMD.013222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1320358Medicaid
LA5C781Medicare ID - Type UnspecifiedMC PROVIDER ID
LA1320358Medicaid