NPIMap

Organization Active NPI

Joshua R Fullmer MD PLLC

  • Ophthalmology Physician
  • Rexburg, ID
National Provider Identifier
1881894517
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
M-9786 Issued in ID
Legal business name
JOSHUA R FULLMER MD PLLC
Practice address
381 E 4TH N Ste 100
Rexburg, ID 83440-1684
Phone
(208) 359-1888
NPI assigned
Jul 20, 2007
Last updated
Jul 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Suzzette Thatcher
Title
Business Manager
Phone
(208) 359-1888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X M-9786 ID Primary

Addresses

Primary practice location

381 E 4TH N Ste 100
Rexburg, ID 83440-1684

Mailing address

381 E 4TH N Ste 100
Rexburg, ID 83440-1684

National Provider Directory

National Provider Directory

Locations

264 E Main St
Rexburg, ID 83440
Phone (208) 359-1888

381 E 4th N
#100
Rexburg, ID 83440
Phone (208) 359-1888

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1881894517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 E 4TH N STE 100",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 E 4TH N STE 100",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401684",
            "telephone_number": "208-359-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSHUA R FULLMER MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "THATCHER",
        "authorized_official_first_name": "SUZZETTE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "208-359-1888"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M-9786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.