Provider Demographics
NPI:1154400174
Name:FUJIMOTO, ERNEST M (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:M
Last Name:FUJIMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 TUCKER BAY CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3150
Mailing Address - Country:US
Mailing Address - Phone:209-477-9465
Mailing Address - Fax:
Practice Address - Street 1:1601 E HAZELTON AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-6229
Practice Address - Country:US
Practice Address - Phone:209-468-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACALIFORNIA A172602083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine