DR. GREGORY W FULLER (NPI# 1174569107) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174569107 |
| Entity Type | Individual |
| Full Name | DR. GREGORY W FULLER |
| Credential | D.O. |
| Practice Address |
1006 Airport Rd Jackson MI 49202-1851 |
| Practice Telephone | 5177846663 |
| Practice Fax Number | 5177877976 |
| Mailing Telephone | 5177846663 |
| Mailing Fax Number | 5177877976 |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2012-05-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
012543 | MI | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | OS5478 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE SHIELD | GF012543 | 01 |
| MI | 114545400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356347306 | Gregory Michael Fuller | Family Medicine | 300 North Rufe Snow Dr, Keller, TX 76248 | 2005-06-23 |
| 1114342128 | Gregory Fuller | Case Management | 1200 N Main St, Suite 200, Santa Ana, CA 92701-3640 | 2014-02-27 |
| 1235267931 | Gregory Alan Fuller | Pharmacist | 103 Utica St, Hamilton, NY 13346-1100 | 2007-03-02 |
| 1023176591 | Gregory Paul Fuller | Dentist | 7255 E Tanque Verde Rd, Ste 101, Tucson, AZ 85715-3463 | 2006-12-05 |
| 1366547937 | Gregory N. Fuller | Pathology | 1515 Holcombe Blvd, Houston, TX 77030-4009 | 2006-09-14 |
| Street Address |
1006 AIRPORT RD |
| City | JACKSON |
| State | MI |
| Zip Code | 49202-1851 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821590316 | Leslie Dominique Barroso | Social Worker | 834 Kennedy St, Jackson, MI 49202 | 2018-03-01 |
| 1073011136 | Nicole Szarek | Social Worker | 1200 N. West Ave, Jackson, MI 49202 | 2018-01-24 |
| 1598299430 | Cedric Griffin | Behavior Technician | 950 W. Monroe St, Jackson, MI 49202 | 2017-04-18 |
| 1285081612 | Patricia Decker | Psychologist | 950 West Monroe, Suite 500, Jackson, MI 49202 | 2016-05-16 |
| 1619344314 | Erica Ries | Social Worker | 1200 N West Ave Ste 800, Jackson, MI 49202 | 2015-08-28 |
| 1184007189 | Sarah Johnson | Behavioral Analyst | 818 Winifred St, Jackson, MI 49202 | 2015-07-08 |
| 1871971697 | Scott A Watterson Dds, Pllc | Dentist | 1030 Laurence Ave, Suite 3, Jackson, MI 49202 | 2015-05-13 |
| 1043608680 | Brenda Beverly | Counselor | 1190 West, 1190 West Suite 812, Jackson, MI 49202 | 2015-01-06 |
| 1295091593 | Natalie Ann Kember | Social Worker | 1206 Clinton, Jackson, MI 49202 | 2012-04-11 |
| 1912218728 | Tina Marie Pierce | Respite Care | 225 N Wisner St, Jakson, MI 49202 | 2010-06-25 |
| Find all providers in zip 49202 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447469135 | Alton Parker | Emergency Medicine | 555 E. Broadway #212, Jackson, WY 83001 | 2007-05-21 |
| 1649383001 | Jeffrey D Greenbaum | Emergency Medicine | 625 E Broadway St, Jackson, WY 83001-0428 | 2006-08-17 |
| 1417318361 | Jacob Robert Russell | Emergency Medicine | 620 Skyline Dr, Jackson, TN 38301 | 2016-03-18 |
| 1972836294 | Independent Observation Physicians Pllc | Emergency Medicine | 205 N East Ave, Jackson, MI 49201-1753 | 2009-09-18 |
| 1700119500 | Independent Observation Physicians Pllc | Emergency Medicine | 205 N East Ave, Jackson, MI 49201-1753 | 2009-09-10 |
| 1538345855 | Emergency Medical Care Facilities PC | Emergency Medicine | 620 Skyline Dr, Jackson, TN 38301-3923 | 2008-01-16 |
| 1881891786 | James Plemon Coleman II | Emergency Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2007-07-02 |
| 1033225354 | Richard A Mckay | Emergency Medicine | 625 E Broadway St, Jackson, WY 83001 | 2006-08-21 |
| 1003922360 | William R Smith | Emergency Medicine | 625 E Broadway, Jackson, WY 83001 | 2006-08-21 |
| 1780797050 | Albert R Wheeler IIi | Emergency Medicine | 625 E Broadway, Jackson, WY 83001-0428 | 2006-08-17 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on DR. GREGORY W FULLER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.