Individual
DR. JEREMY D FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 526-2200
(304) 399-6726
Mailing address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 526-2200
(304) 399-1507
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21688
WV
207Q00000X
Family Medicine Physician
21688
WV
207Q00000X
Family Medicine Physician
TP578
KY
207QS0010X
Sports Medicine (Family Medicine) Physician
21688
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285713156
—
WV
05
—
2783519
—
OH
05
—
7100048840
—
KY
Enumeration date
11/03/2006
Last updated
03/07/2023
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