Provider Demographics
NPI:1972561769
Name:FULMER, CHERE LYNN (MD)
Entity type:Individual
Prefix:
First Name:CHERE
Middle Name:LYNN
Last Name:FULMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 E SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2003
Mailing Address - Country:US
Mailing Address - Phone:334-286-2390
Mailing Address - Fax:334-286-2397
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2001
Practice Address - Country:US
Practice Address - Phone:334-286-2390
Practice Address - Fax:334-286-2397
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00027069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL203204949OtherUNITED HEALTHCARE
AL009938457Medicaid
AL203204949OtherCOMMERICIAL PRV
AL203204949OtherCOMMERICIAL GRP
AL203204949OtherWORKMAN COMP
ALP00384687OtherRAILROAD MEDICARE
AL051003798OtherBLUE CROSS BLUE SHIELD
AL203204949OtherCHAMPUS
AL203204949OtherCOMMERICIAL GRP