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General NPI Number Information
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NPI Number | 1134112949
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Entity Type | Individual
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Provider Name | LEO E FUTRELL III M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 651 N BOLTON AVE
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City | ALEXANDRIA
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State | LA
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Zip | 71301-7449
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Country | US
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Telephone | 318-443-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 420 N BAYOU RAPIDES RD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-7738
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Country | US
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Telephone | 318-484-5205
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Fax | 318-442-3134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 014154
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License Number State | LA
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