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Contact Information

IRA B FULLER III III, MD
433 PLAZA ST
BOGALUSA, LA70427-3729
 Phone: 985-730-6705
 Fax: 985-730-6709
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Ophthalmology

207W00000X 18 Physician/Ophthalmology
Indicates primary specialty

NPI Profile & details for IRA B FULLER III III · (Male)

NPI Number 1134149081
Status Active
Credentials MD
Entity Individual
Enumeration date 07/20/2006
Last updated 01/13/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • LA License # 06356R
  • LA Medicaid 1341428
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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