Individual
TOMMY LESTER FUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
604 N ACADIA RD, SUITE 409, THIBODAUX, LA 70301
(985) 449-4670
(985) 449-2598
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 449-4670
(985) 449-2598
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
03512R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1365475
—
LA
01
—
P00790563
RR MEDICARE
LA
Enumeration date
07/05/2005
Last updated
07/05/2018
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