Provider Demographics
NPI:1003084054
Name:GERALD L. FORET, JR., MD, L.L.C.
Entity type:Organization
Organization Name:GERALD L. FORET, JR., MD, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-448-4969
Mailing Address - Street 1:PO BOX 13688
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3688
Mailing Address - Country:US
Mailing Address - Phone:318-448-4999
Mailing Address - Fax:
Practice Address - Street 1:1804 MACARTHUR DR
Practice Address - Street 2:SUITE 400
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3758
Practice Address - Country:US
Practice Address - Phone:318-448-4969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1377953Medicaid
LA1377953Medicaid