Provider Demographics
NPI:1346357308
Name:DOLLAR, CINDY FULLER (MD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:FULLER
Last Name:DOLLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2355
Mailing Address - Country:US
Mailing Address - Phone:318-388-8124
Mailing Address - Fax:318-388-8134
Practice Address - Street 1:3421 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2355
Practice Address - Country:US
Practice Address - Phone:318-388-8124
Practice Address - Fax:318-388-8134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022599282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494194Medicaid
LAG71351Medicare UPIN
LA1494194Medicaid