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Individual

DR. ERIC J. FULNECKY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1900 S NATIONAL AVE, SUITE 2955, SPRINGFIELD, MO 65804-2265
(417) 820-3905
(417) 820-3528
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316

Taxonomy

Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
2004006990
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
209153907
MO
01
431560263
TRICARE
01
P00207385
RAILROAD MEDICARE
Enumeration date
12/01/2006
Last updated
07/11/2008
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