Most Relevant Information
Provider Data
| NPI Number: | 1003827601 |
| Provider Name: | JEFFERY FULLER M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 207P00000X |
| Specialty: | Emergency Medicine |
| License Number: | 018474 |
Most Important Dates
| Enumeration Date: | 08/10/2006 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
4864 JACKSON ST
DEPARTMENT OF EMERGENCY MEDICAL SERVICES
MONROE
LA
712026400
Practice Location Phone/Fax
| Phone: | 3186757737 |
| Fax: | 3186755666 |
Provider Mailing Location
1501 KINGS HWY
MANAGED CARE
SHREVEPORT
LA
71103
Provider Mailing Phone/Fax
| Phone: | 3186757737 |
| Fax: | 3186755666 |