Basic Information
| Provider Information | |||||||||
| NPI: | 1275680357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLEURY | ||||||||
| FirstName: | MARKESHA | ||||||||
| MiddleName: | WINN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WINN | ||||||||
| OtherFirstName: | MARKESHA | ||||||||
| OtherMiddleName: | YVETTE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1414 FAIRCHILD ST | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708074913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257741120 | ||||||||
| FaxNumber: | 2257741171 | ||||||||
| Practice Location | |||||||||
| Address1: | 1414 FAIRCHILD ST | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708074913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257741120 | ||||||||
| FaxNumber: | 2257741171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 15770R | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1468495 | 05 | LA | MEDICAID |