Provider Demographics
NPI:1831219922
Name:J. P. FORAGE, M.D., P.A.
Entity type:Organization
Organization Name:J. P. FORAGE, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-443-5954
Mailing Address - Street 1:11645 ANGUS RD
Mailing Address - Street 2:STE B-6
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4020
Mailing Address - Country:US
Mailing Address - Phone:512-443-5954
Mailing Address - Fax:512-326-3433
Practice Address - Street 1:11645 ANGUS RD
Practice Address - Street 2:STE B-6
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4020
Practice Address - Country:US
Practice Address - Phone:512-443-5954
Practice Address - Fax:512-326-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5050208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0831836-01Medicaid
TXPR29114470001OtherCIGNA VENDOR #
TX0831836-01Medicaid