Individual
ANDREW JOSEPH FULLER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MEDICAL CENTER DR, SLIDELL, LA 70461-5520
(985) 646-5189
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
204996
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06059043
—
MS
05
—
2106546
—
LA
Enumeration date
03/19/2010
Last updated
09/16/2015
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