Individual
ANNALIESA FANGUY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5400 E TEXAS ST, BOSSIER CITY, LA 71111-6906
(318) 675-1313
Mailing address
611 E DOUGLAS RD STE 407, MISHAWAKA, IN 46545-1468
(574) 335-6500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
348260
LA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
348260
LA
Other
Enumeration date
07/29/2025
Last updated
04/06/2026
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