Individual
JUAN M FUKUDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4600 AMBASSADOR CAFFERY PKWY, PEDIATRIC EMERGENCY MEDICINE, LAFAYETTE, LA 70508-6902
(337) 521-9027
(337) 521-9164
Mailing address
4600 AMBASSADOR CAFFERY PKWY, PEDIATRIC EMERGENCY MEDICINE, LAFAYETTE, LA 70508-6902
(337) 521-9027
(337) 521-9164
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
14374R
LA
208000000X
Pediatrics Physician
14374R
LA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
14374R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1113166
—
LA
Enumeration date
08/26/2005
Last updated
02/04/2011
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