Provider Demographics
NPI:1760489637
Name:FOREST, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:FOREST
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:BUILDING 16
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6984
Mailing Address - Country:US
Mailing Address - Phone:337-406-8009
Mailing Address - Fax:337-406-8010
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BUILDING 16
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6984
Practice Address - Country:US
Practice Address - Phone:337-406-8009
Practice Address - Fax:337-406-8010
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2013-09-25
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Provider Licenses
StateLicense IDTaxonomies
LA11767R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1682063Medicaid
G31900Medicare UPIN
LA1682063Medicaid