Provider Demographics
NPI:1750888053
Name:FOUGEROUSSE, JOSEPH ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLEN
Last Name:FOUGEROUSSE
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 1:8080 BLUEBONNET BLVD STE 3000
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7829
Mailing Address - Country:US
Mailing Address - Phone:225-766-8100
Mailing Address - Fax:225-408-6873
Practice Address - Street 1:8080 BLUEBONNET BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7829
Practice Address - Country:US
Practice Address - Phone:225-766-8100
Practice Address - Fax:225-408-6873
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA338173208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology