Provider Demographics
NPI:1578359691
Name:FULGENCE, JOHN GARY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GARY
Last Name:FULGENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-0420
Mailing Address - Country:US
Mailing Address - Phone:337-739-2232
Mailing Address - Fax:
Practice Address - Street 1:116 PERSHING ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-5038
Practice Address - Country:US
Practice Address - Phone:337-739-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007143414347C00000X
LA007149414347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle