Charles S Fulk (NPI# 1801848668, PAC ID# 2163412958) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1801848668 |
| PAC ID by PECOS | 2163412958 |
| Professional Enrollment ID | I20040525001231 |
| Full Name | Charles S Fulk |
| Organization Legal Name | LAKEWAY DERMATOLOGY ASSOCIATES PC |
| Address |
112 W Broadway Blvd Jefferson City TN 37760-1942 |
| Phone Number | 8652628240 |
| Gender | M |
| Credential | MD |
| Medical School | BOWMAN GRAY SCHOOL OF MEDICINE OF WAKE FOREST UNIVERSITY |
| Graduation Year | 1973 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 3678892684 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 112 W Broadway Blvd, Jefferson City, TN 37760-1942 | 8652628240 | LAKEWAY DERMATOLOGY ASSOCIATES PC |
| Organization Legal Name | LAKEWAY DERMATOLOGY ASSOCIATES PC |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Daniel L Kachelmyer | Physician Assistant | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Vita L Mayes | Physician Assistant | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Conrad L Brimhall | Dermatology | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Ann E Ayres | Physician Assistant | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Street Address |
112 W BROADWAY BLVD |
| City | JEFFERSON CITY |
| State | TN |
| Zip | 37760-1942 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Daniel L Kachelmyer | Physician Assistant | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Vita L Mayes | Physician Assistant | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Conrad L Brimhall | Dermatology | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Ann E Ayres | Physician Assistant | Lakeway Dermatology Associates PC | 112 W Broadway Blvd, Jefferson City, TN 37760-1942 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Richard Jeffrey Munson | Psychologist, Clinical | 104 W Old Andrew Johnson Hwy, Suite B, Jefferson City, TN 37760-1949 | |
| William J Williams | Internal Medicine | 1526 Meadow Spring Dr, Jefferson City, TN 37760-2041 | |
| Robert A Matijevich | Physical Therapy | 1405 S Sizer Ave, B, Jefferson City, TN 37760-2436 | |
| Dennis U Spjut | Psychologist, Clinical | 732 E Jefferson St, Jefferson City, TN 37760-2514 | |
| Annita J Rowland | Nurse Practitioner | Express Health Clinic Corporation | 153 E Broadway Blvd, Jefferson City, TN 37760-2517 |
| Barbara A Brock | Nurse Practitioner | Express Health Clinic Corporation | 153 E Broadway Blvd, Jefferson City, TN 37760-2517 |
| Brenda Badawi | Nurse Practitioner | Express Health Clinic Corporation | 153 E Broadway Blvd, Jefferson City, TN 37760-2517 |
| Jeannie B Levi | Nurse Practitioner | Express Health Clinic Corporation | 153 E Broadway Blvd, Jefferson City, TN 37760-2517 |
| Kristin S Kramer | Nurse Practitioner | Express Health Clinic Corporation | 153 E Broadway Blvd, Jefferson City, TN 37760-2517 |
| Mary Lou Cameron | Nurse Practitioner | Express Health Clinic Corporation | 153 E Broadway Blvd, Jefferson City, TN 37760-2517 |
| Find all physicians in zip 37760 | |||
| City | JEFFERSON CITY |
| Zip Code | 37760 |
| Specialty | DERMATOLOGY |
| City + Specialty | JEFFERSON CITY + DERMATOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.