John Carr Fullerton III, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G2136 Issued in TX

Practice address

1901 S 1St St
General Surgery SVC-112
Temple, TX 76504-7451

Phone

(254) 778-4811

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831102011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 INDIAN TRL",
            "city": "SALADO",
            "state": "TX",
            "postal_code": "765715492",
            "telephone_number": "254-947-5976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S 1ST ST",
            "address_2": "GENERAL SURGERY SVC-112",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765047451",
            "telephone_number": "254-778-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "JOHN",
        "middle_name": "CARR",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E0099",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "G2136",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101031485",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor Hyrum Fuhriman
• Samuel F. Fulcher, M.D.
• Allie Marie Fuller, M.D.
• Charissa Fuller, APRN, FNP-C
• Janice Myetta Fullerton, PMHNP-BC
• Zachary Tyler Fulp
• Alec Hill Fulton, MD
• Carolyn N Fulton, LSA
• Harleigh Allyn Funderburk, PA-C
• Sandra Lee Funderburk

• Surgery Physician in Temple, TX
• Providers in Temple, TX by specialty
• Surgery Physician in Texas

• 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.

Verify at the official NPI Registry.