Organization
SOUTHWEST MISSOURI INFECTIOUS DISEASE LLC
Active
Organization
SOUTHWEST MISSOURI INFECTIOUS DISEASE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC JEROME FULNECKY M.D. (OWNER)
(417) 459-1711
Entity
Organization
Contact information
Practice address
2872 S FORREST HEIGHTS AVE, SPRINGFIELD, MO 65809-3417
(417) 459-1711
Mailing address
2872 S FORREST HEIGHTS AVE, SPRINGFIELD, MO 65809-3417
(417) 459-1711
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
2004006990
MO
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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