DR. MARK ALLEN FULLMER (NPI# 1457420853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457420853 |
| Entity Type | Individual |
| Full Name | DR. MARK ALLEN FULLMER |
| Credential | M.D. |
| Practice Address |
1055 N 300 W Suite 418 Provo UT 84604-3344 |
| Practice Telephone | 8013577100 |
| Practice Fax Number | 8013578100 |
| Mailing Telephone | 8013577100 |
| Mailing Fax Number | 8013578100 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2012-07-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 152450-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | DEA NUMBER | AF4455108 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568684470 | Mark Crandall Fullmer | Dentist | 225 East 400 South, Springville, UT 84663 | 2007-05-02 |
| 1003023425 | Mark Douglas Fullmer | Chiropractor | 471 Ainsley Ave, Yuba City, CA 95991-4105 | 2007-05-16 |
| Street Address |
1055 N 300 W SUITE 418 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3344 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851397491 | Paul Ferron Olson | Specialist | 1055 N 300 W, Ste 204, Provo, UT 84604-3374 | 2005-06-27 |
| 1215351416 | Jenny Coy | Nurse Practitioner | 1055 N 300 W, Ste 401, Provo, UT 84604-3306 | 2014-02-07 |
| 1356682553 | Andrea Lee Driggs | Nurse Practitioner | 1055 N 300 W, Suite 110, Provo, UT 84604-3344 | 2013-03-13 |
| 1003151853 | Sharla Morgan | Nurse Practitioner | 1055 N 300 W, Suite 212, Provo, UT 84604-3344 | 2012-12-05 |
| 1720356538 | Ihc Health Services Inc | Surgery | 1055 N 300 W, Ste 205, Provo, UT 84604-5044 | 2011-12-07 |
| 1053691246 | Steven Forsey | Audiologist | 1055 N 300 W, Ste 401, Provo, UT 84604-3344 | 2011-08-19 |
| 1417241704 | Ihc Health Services Inc | Psychiatry & Neurology | 1055 N 300 W, Ste 501, Provo, UT 84604-3344 | 2011-06-03 |
| 1134435837 | George C Gourley, Do | Obstetrics & Gynecology | 1055 N 300 W, Suite 305, Provo, UT 84604-3344 | 2010-08-19 |
| 1972818185 | Joseph Evans Dansie | Audiologist | 1055 N 300 W, Suite 401, Provo, UT 84604-3344 | 2010-08-11 |
| 1619293552 | Charles Brent Stubbs | Pharmacist | 1055 N 300 W, Suite 201, Provo, UT 84604-3344 | 2010-04-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164528717 | Brian Gill | Surgery | 3550 N. University Ave. #250, Provo, UT 84604 | 2006-09-14 |
| 1851347090 | Craig S Cook | Surgery | 3550 N University Ave, Ste 250, Provo, UT 84604 | 2006-05-26 |
| 1770767964 | Craig W Morrison | Surgery | 1750 N Wymount Terrace Dr, Provo, UT 84601-4800 | 2007-12-24 |
| 1700932068 | David Michael Watts | Surgery | 3550 N University Ave, Suite 250, Provo, UT 84604-6683 | 2007-01-26 |
| 1669521571 | Karl M Francis Jr. | Surgery | 3550 N University Ave Ste 250, Provo, UT 84604-6685 | 2007-01-09 |
| 1568497634 | Jennifer J Tittensor | Surgery | 3550 N University Ave, Ste 250, Provo, UT 84604 | 2006-07-11 |
| 1316987613 | Lee M Peterson | Surgery | 3550 N University Ave, Suite 250, Provo, UT 84604 | 2006-06-07 |
| 1215977517 | Richard M Thomas | Surgery | 3550 N University Ave, Suite #250, Provo, UT 84604 | 2006-06-07 |
| 1528008588 | R Richard Rasmussen | Surgery | 1055 N 300 W, Ste 302, Provo, UT 84604-3344 | 2006-06-07 |
| 1699715664 | Bruce B Hill | Surgery | 3550 N University Ave, Suite 250, Provo, UT 84604 | 2006-06-07 |
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| 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.