Provider Demographics
NPI:1053371997
Name:FORET, EDISON JAMES (MD)
Entity type:Individual
Prefix:
First Name:EDISON
Middle Name:JAMES
Last Name:FORET
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 1:1022 BELANGER ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4412
Mailing Address - Country:US
Mailing Address - Phone:985-868-1561
Mailing Address - Fax:985-868-5795
Practice Address - Street 1:1022 BELANGER ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4412
Practice Address - Country:US
Practice Address - Phone:985-868-1561
Practice Address - Fax:985-868-5795
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200323207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1628280Medicaid
LA1628280Medicaid
I36540Medicare UPIN