Individual
BLAKE FULKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1423 N JEFFERSON AVE # B100, SPRINGFIELD, MO 65802-1917
(417) 269-8817
(417) 269-8744
Mailing address
1423 N JEFFERSON AVE # B100, SPRINGFIELD, MO 65802-1917
(417) 269-8817
(417) 269-8744
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2015020398
MO
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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