Individual
MR. ERIK DEE FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC CANIDATE
Contact information
Practice address
134 SE 5TH AVE, SUITE C, HILLSBORO, OR 97123-4095
(503) 648-5269
(503) 648-5269
Mailing address
134 SE 5TH AVE, SUITE C, HILLSBORO, OR 97123-4095
(503) 648-5269
(503) 648-5269
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278095
—
OR
Enumeration date
04/19/2016
Last updated
04/19/2016
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