Individual
JEFFREY D FULLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19250 SW 65TH AVE, STE 110, TUALATIN, OR 97062-7452
(503) 692-1205
(503) 692-1207
Mailing address
1411 SW MORRISON ST, STE 200, PORTLAND, OR 97205-1945
(503) 242-9850
(503) 279-8157
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD13393
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
282301
—
OR
Enumeration date
03/14/2006
Last updated
07/19/2010
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