Individual
DR. JACE PAUL FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5121 S COTTONWOOD ST, SALT LAKE CITY, UT 84107-5701
(801) 507-9700
Mailing address
5121 S COTTONWOOD ST, SALT LAKE CITY, UT 84107-5701
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9415721-1204
UT
Other
Enumeration date
03/23/2011
Last updated
12/19/2015
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