Provider Demographics
NPI:1598031122
Name:FULTON, LATOYA DENISE (DO)
Entity Type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:DENISE
Last Name:FULTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:DENISE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3625 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4229
Mailing Address - Country:US
Mailing Address - Phone:662-392-6204
Mailing Address - Fax:
Practice Address - Street 1:501 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7336
Practice Address - Country:US
Practice Address - Phone:504-393-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5874207Q00000X, 390200000X
GA3990200000X390200000X
LA307098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program