Provider Demographics
NPI:1932252103
Name:FORET, VERNON J (PAC)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:J
Last Name:FORET
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18838 HIGHWAY 3235
Mailing Address - Street 2:
Mailing Address - City:GALLIANO
Mailing Address - State:LA
Mailing Address - Zip Code:70354-4038
Mailing Address - Country:US
Mailing Address - Phone:985-475-5522
Mailing Address - Fax:985-475-4822
Practice Address - Street 1:18838 HIGHWAY 3235
Practice Address - Street 2:
Practice Address - City:GALLIANO
Practice Address - State:LA
Practice Address - Zip Code:70354-4038
Practice Address - Country:US
Practice Address - Phone:985-475-5522
Practice Address - Fax:985-475-4822
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10413RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical