Individual
DR. GREGORY W FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1006 AIRPORT RD, JACKSON, MI 49202-1851
(517) 784-6663
(517) 787-7976
Mailing address
1006 AIRPORT RD, JACKSON, MI 49202-1851
(517) 784-6663
(517) 787-7976
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101012543
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
012543
MI
207Q00000X
Family Medicine Physician
OS5478
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114545400
—
MI
01
—
GF012543
BLUE SHIELD
MI
Enumeration date
06/20/2006
Last updated
09/23/2021
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