Fukuda, Juan M

Fukuda, Juan M is an individual health care provider with primary practice located at 4600 Ambassador Caffery Pkwy Pediatric Emergency Medicine, Lafayette LA 70508-6902. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Other Service Providers / Specialist is his primary health care specialty. Fukuda, Juan M can be contacted via phone (337) 521-9027.

Contact Information

Primary practice address
4600 Ambassador Caffery Pkwy Pediatric Emergency Medicine Lafayette LA 70508-6902
Phone: (337) 521-9027
Fax: (337) 521-9164
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 14374R Louisiana
Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine 2080P0204X 14374R Louisiana
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 14374R Louisiana

Profile Details

NPI number 1154314904
LBN Legal business name Fukuda, Juan M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 26th, 2005
Last updated Feb 4th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154314904 NPPES
Louisiana MEDICAID 1113166

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