Provider Demographics
NPI:1396789764
Name:FORAGE, JEAN-PIERRE (MD)
Entity type:Individual
Prefix:
First Name:JEAN-PIERRE
Middle Name:
Last Name:FORAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J.P.
Other - Middle Name:
Other - Last Name:FORAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11645 ANGUS RD
Mailing Address - Street 2:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5050208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80T081OtherBCBS INDIVIDUAL #
TX113863802Medicaid
TX083183601Medicaid
TX742638492OtherTAX ID
TX113863802Medicaid
TX742638492OtherTAX ID
TX083183601Medicaid