NPIMap

Individual provider Active NPI

Elzer T. Fuller Jr., M.D.

  • General Practice Physician
  • London, KY
National Provider Identifier
1013961986
Registry record updated Jan 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
19010 Issued in KY
Practice address
969 Laurel Cove Rd
London, KY 40741-9024
Phone
(606) 843-2548
Fax
(859) 873-0115
NPI assigned
May 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 19010 KY Primary
Emergency Medicine Physician 207P00000X ME58598 FL
Emergency Medicine Physician 207P00000X 19010 KY

Addresses

Primary practice location

969 Laurel Cove Rd
London, KY 40741-9024

Mailing address

969 Laurel Cove Rd
London, KY 40741-9024
Phone (606) 843-2548

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

LicenseStateTypeSpecialty
19010KYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland Clinic, PLLC Past Accepting new patients
United Emergency Services, Inc. Emergency Medicine Past Accepting new patients
Middlesborough Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Ky-I Medical Services, P.S.C. Past Accepting new patients
Memorial Hospital Inc. Past Accepting new patients
Apogee Medical Group Kentucky PSC General Practice PastSince Mar 1, 2010 Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389571200000",
    "number": "1013961986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "969 LAUREL COVE RD",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407419024",
            "telephone_number": "606-843-2548",
            "fax_number": "859-873-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAUREL COVE RD",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407419024",
            "telephone_number": "606-843-2548",
            "fax_number": "859-873-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "ELZER",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2014-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "KY",
            "license": "19010",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME58598",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "19010",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.