Individual
DR. IRA BUTLER FULLER III III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
433 PLAZA ST, BOGALUSA, LA 70427-3729
(985) 730-6705
(985) 730-6709
Mailing address
3401 NORTH BLVD, BATON ROUGE, LA 70806-3743
(225) 924-6820
(225) 928-5334
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
06356R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1341428
—
LA
Enumeration date
07/20/2006
Last updated
01/13/2009
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