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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