Individual
DR. JASON FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11111 RESEARCH BLVD, SUITE 300, AUSTIN, TX 78759-5264
(512) 380-9200
(512) 380-9201
Mailing address
11111 RESEARCH BLVD, SUITE 300, AUSTIN, TX 78759-5264
(512) 380-9200
(512) 380-9201
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
L0800
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154700203
—
TX
Enumeration date
11/14/2006
Last updated
12/16/2014
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