Individual
DR. JON M. FUSSELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3231 S NATIONAL AVE, SPRINGFIELD, MO 65807-7304
(417) 885-0810
(417) 888-6740
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
106781
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127785001
—
AR
05
—
201601614
—
MO
01
—
82165
AR BLUE SHIELD #
MO
Enumeration date
02/15/2007
Last updated
07/22/2008
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