DR. TIMOTHY RICHARD FULLAM (NPI# 1952720104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952720104 |
| Entity Type | Individual |
| Full Name | DR. TIMOTHY RICHARD FULLAM |
| Credential | M.D. |
| Practice Address |
301 Fisher Street 81 Mdos/sgomu Keesler Afb MS 39564 |
| Mailing Address |
301 Fisher Street 81 Mdos/sgomu Keesler Afb MS 39564-2519 |
| Practice Telephone | 2283765378 |
| Practice Fax Number | 2283760581 |
| Mailing Telephone | 2283765378 |
| Mailing Fax Number | 2283760581 |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2018-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 28833 | NE | Allopathic & Osteopathic Physicians |
| Street Address |
301 FISHER STREET 81 MDOS/SGOMU |
| City | KEESLER AFB |
| State | MS |
| Zip Code | 39564 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114488517 | Benjamin Joseph Marcheschi | Student in an Organized Health Care Education/Training Program | 301 Fisher Street, Room 5a127, Keesler Afb, MS 39534 | 2019-03-27 |
| 1306124839 | Karen Lashea Williams | Nurse Practitioner | 301 Fisher Street, Keesler Afb Medical Group, Keesler Afb, MS 39534 | 2011-08-02 |
| 1982765186 | Lynn Vix | Preventive Medicine | 301 Fisher Street, Keesler Afb, MS 39534 | 2006-12-12 |
| 1063525632 | James Jude Renda | Dentist | 301 Fisher Street, 81st Dental Squadron, Keesler Afb, MS 39534 | 2006-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750996401 | Shelby Bourgeois | Speech-Language Pathologist | 108 Heron Park Pl, Ocean Springs, MS 39564 | 2020-09-10 |
| 1467010520 | Rachel Stephenie Knox | Student in an Organized Health Care Education/Training Program | 81mdss/gme 301 Fisher St., Rm 1g123, Keesler Afb, MS 39564 | 2019-06-04 |
| 1457839292 | Polly Anne Lampon | Registered Nurse | 2301 Rue Beaux Chenes, Ocean Springs, MS 39564 | 2018-08-03 |
| 1578062725 | Gulf Coast Sleep Medicine LLC | Clinic/Center | 2112 Bienville Blvd., Suite P, Ocean Springs, MS 39564 | 2018-02-02 |
| 1598212623 | Edward Victor Brown Jr. | Dentist | 15465 Oak Lane, Gulfport, MS 39564 | 2016-09-07 |
| 1386016749 | L. Randy Buntyn, D.m.d., Pllc | Dentist | 1203 Government St., Ocean Springs, MS 39564 | 2015-10-26 |
| 1467835629 | Msmobileyes Inc. | Optometrist | 2510 Bileville Blvd, Ocean Springs, MS 39564 | 2015-07-07 |
| 1659760999 | Clark Jamison Levi | Pharmacist | 1019 Government Street Suite F & D, Ocean Springs, MS 39564 | 2015-01-09 |
| 1932545480 | Therese Anne Hanna | Nurse Practitioner | 6900 Washington Avenue, Ocean Springs, MS 39564 | 2013-05-10 |
| 1346589421 | Jennah Claine Ladner | Nurse Practitioner | 1137 Ocean Springs Road, Ocean Springs, MS 39564 | 2013-02-08 |
| Find all providers in zip 39564 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316306079 | Amanda Delgado | General Practice | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2016-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487260329 | Good Shepard LLC | General Practice | 632 Lakeland East Dr, Flowood, MS 39232-9565 | 2020-09-16 |
| 1518500677 | Nettleton Medical Express Care LLC | General Practice | 7230 Highway 45 N Ste B, 32610 Hwy 45 N, Nettleton, MS 38858 | 2019-10-22 |
| 1780241729 | Southeast Reginald Solutions,pllc | General Practice | 310 River Forest Ln, Brandon, MS 39047-7020 | 2019-05-24 |
| 1235601907 | William Carey University | General Practice | 710 William Carey Pkwy, Hattiesburg, MS 39401-7842 | 2018-12-19 |
| 1770050908 | Thompson Medical Service, LLC | General Practice | 1200 Hwy 15 North, Blue Mountain, MS 38610 | 2018-10-25 |
| 1790265932 | Antonio Reyes Del Castillo Jr. | General Practice | 590 Parchman Road 12, Parchman, MS 38738-3001 | 2018-08-16 |
| 1700397239 | Marysol Camejo Romero | General Practice | 728 Benwick Dr, Brandon, MS 39047-8111 | 2017-10-24 |
| 1013431519 | Madena Jane Gibson | General Practice | 1695 Moses Rd, Raymond, MS 39154-8766 | 2017-07-27 |
| 1942740188 | Personalized Wellness | General Practice | 573 Highway 51 Ste D, Ridgeland, MS 39157-2605 | 2017-03-07 |
| 1366991523 | Jackson State University | General Practice | 1400 Jr Lynch St, Jackson, MS 39217-0002 | 2016-09-29 |
| Find all providers with the same taxonomy | ||||
| City | KEESLER AFB |
| Zip Code | 39564 |
Please comment or provide details below to improve the information on DR. TIMOTHY RICHARD FULLAM.
| 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.