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Individual

DR. BRIAN LEE FONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2965 GAUSE BLVD E, SUITE A, SLIDELL, LA 70461-4154
(985) 641-7775
(985) 641-1166
Mailing address
1209 BLUFF DR, SLIDELL, LA 70461-5081
(985) 847-0621
(985) 641-1166

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
10265R
LA
207X00000X
Orthopaedic Surgery Physician
MD7157
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1194920001
DME MEDICARE
01
200030274
RAILROAD MEDICARE
01
C7760
BLUE CROSS
Enumeration date
09/23/2005
Last updated
08/31/2020
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