Basic Information
| Provider Information | |||||||||
| NPI: | 1295988517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURR | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | A. | ||||||||
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| NameSuffix: | III | ||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 MCMILLAN RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | WEST MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712915327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776935700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 861 SW 78TH AVE | ||||||||
| Address2: | # 100B | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776935700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2008 | ||||||||
| LastUpdateDate: | 10/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.200033 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.