Individual
RONALD F FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1325
(208) 422-1319
Mailing address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1325
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
M5186
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001287500
—
ID
01
—
P00029394
RR MEDICARE
ID
Enumeration date
06/15/2006
Last updated
04/05/2022
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