Active NPI
Jeffery Fuller, M.D.
- Emergency Medicine Physician
- Monroe, LA
National Provider Identifier
1003827601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 018474
- Practice address
- 4864 Jackson St
Department of Emergency Medical Services
Monroe, LA 71202-6400 - Phone
- (318) 675-7737
- Fax
- (318) 675-5666
- NPI assigned
- Aug 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 018474 | LA | Primary |
Addresses
Primary practice location
4864 Jackson St
Department of Emergency Medical Services
Monroe, LA 71202-6400
Mailing address
1501 Kings Hwy
Managed Care
Shreveport, LA 71103
Phone (318) 675-7737
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1357723 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018474 | LA | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003827601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"address_2": "MANAGED CARE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71103",
"telephone_number": "318-675-7737",
"fax_number": "318-675-5666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4864 JACKSON ST",
"address_2": "DEPARTMENT OF EMERGENCY MEDICAL SERVICES",
"city": "MONROE",
"state": "LA",
"postal_code": "712026400",
"telephone_number": "318-675-7737",
"fax_number": "318-675-5666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "JEFFERY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "LA",
"license": "018474",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1357723",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.