Individual
DR. JACOB I FULKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202
(502) 852-5689
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
46144
KY
207P00000X
Emergency Medicine Physician
LL32875
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100247730
—
KY
Enumeration date
06/27/2010
Last updated
03/03/2021
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