Provider Demographics
NPI:1568446821
Name:FOCH, BERTRAND JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTRAND
Middle Name:JOSEPH
Last Name:FOCH
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 1:707A E PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8613
Mailing Address - Country:US
Mailing Address - Phone:337-475-3200
Mailing Address - Fax:337-475-3222
Practice Address - Street 1:707A E PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8613
Practice Address - Country:US
Practice Address - Phone:337-475-3200
Practice Address - Fax:337-475-3222
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018210208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1913502Medicaid
E20768Medicare UPIN
LA1913502Medicaid