Provider Demographics
NPI:1306838206
Name:DUGAS, BRISCO FORREST (MD)
Entity Type:Individual
Prefix:DR
First Name:BRISCO
Middle Name:FORREST
Last Name:DUGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1856
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1856
Mailing Address - Country:US
Mailing Address - Phone:985-345-2727
Mailing Address - Fax:985-345-9612
Practice Address - Street 1:15742 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1446
Practice Address - Country:US
Practice Address - Phone:985-345-2727
Practice Address - Fax:985-345-9612
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015135208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330078Medicaid
LAD79777Medicare UPIN
LA1330078Medicaid