Provider Demographics
NPI:1720053101
Name:FULLER, JAMES H (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:FULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING AND RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:15761 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4176
Practice Address - Country:US
Practice Address - Phone:239-415-8377
Practice Address - Fax:239-415-8770
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME12279207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051414400Medicaid
FL4237105OtherAETNA
FLP107611OtherFREEDOM HEALTH
FLP952479OtherOPTIMUM
FL102044OtherAVMED
FL16628OtherBCBS OF FL
FL2524858OtherCIGNA
FLP01283315OtherRAILROAD MCR
FL16628OtherBCBS OF FL
FL051414400Medicaid