Individual
LORI FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3277 LIBERTY BLVD # A, BOONVILLE, IN 47601-9659
(812) 897-8500
Mailing address
3277 LIBERTY BLVD # A, BOONVILLE, IN 47601-9659
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036109A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200526160
—
IN
Enumeration date
11/10/2005
Last updated
10/05/2022
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