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Individual

JUSTIN DAVID FOWLKES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
15813 PAUL VEGA MD DR STE 401A, HAMMOND, LA 70403-1426
(985) 230-1580
(985) 230-1585
Mailing address
15813 PAUL VEGA MD DR STE 401, HAMMOND, LA 70403-1426

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD.204656
LA
207RP1001X
Pulmonary Disease Physician
Primary
MD.204656
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2106520
LA
Enumeration date
03/19/2010
Last updated
09/15/2017
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