# BRIAN L. FONG, MD, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205075207
- **Authorized official:** BRIAN L FONG MD (PRESIDENT)
- **Authorized official phone:** (985) 641-7775

## Contact information

- **Practice address:** 2250 GAUSE BLVD E, SUITE 200, SLIDELL, LA 70461-4235
- **Practice address phone:** (985) 641-7775
- **Practice address fax:** (985) 641-1166
- **Mailing address:** 2250 GAUSE BLVD E, PMB \#51058, SLIDELL, LA 70461-4235
- **Mailing address phone:** (985) 641-7775
- **Mailing address fax:** (985) 641-1166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 10265R | LA | Yes |

## Other

- **Enumeration date:** 02/13/2009
- **Last updated:** 09/08/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 200030274 | RAILROAD MEDICARE | LA |
| 01 | — | C7760 | BLUE CROSS | LA |