Provider Demographics
NPI:1710272919
Name:FOREMAN, DEREK SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:SCOTT
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LA RUE FRANCE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3104
Mailing Address - Country:US
Mailing Address - Phone:337-264-9787
Mailing Address - Fax:337-264-9506
Practice Address - Street 1:200 LA RUE FRANCE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3104
Practice Address - Country:US
Practice Address - Phone:337-264-9787
Practice Address - Fax:337-264-9506
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant