Organization
BRIAN L. FONG, MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN L FONG MD (PRESIDENT)
(985) 641-7775
Entity
Organization
Contact information
Practice address
2250 GAUSE BLVD E, SUITE 200, SLIDELL, LA 70461-4235
(985) 641-7775
(985) 641-1166
Mailing address
2250 GAUSE BLVD E, PMB #51058, SLIDELL, LA 70461-4235
(985) 641-7775
(985) 641-1166
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
10265R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200030274
RAILROAD MEDICARE
LA
01
—
C7760
BLUE CROSS
LA
Enumeration date
02/13/2009
Last updated
09/08/2009
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