Provider Demographics
NPI:1134112949
Name:FUTRELL, LEO E III (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:E
Last Name:FUTRELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N BAYOU RAPIDES RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-7738
Mailing Address - Country:US
Mailing Address - Phone:318-484-5205
Mailing Address - Fax:318-442-3134
Practice Address - Street 1:651 N BOLTON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-7449
Practice Address - Country:US
Practice Address - Phone:318-443-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014154207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00172212OtherRAILROAD MEDICARE
LA1304221Medicaid
LAB61359Medicare UPIN
LA5L544Medicare PIN