Individual
DR. JONATHAN ELLIS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
20813
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0511642
—
IA
01
—
07113
BCBS
NE
01
—
200031840
RAILROAD MEDICARE
NE
05
—
47081304012
—
NE
Enumeration date
05/31/2005
Last updated
01/28/2009
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