Jeffrey D Fullman, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD13393 Issued in OR

Practice address

19250 SW 65TH Ave
Ste 110
Tualatin, OR 97062-7452

Phone

(503) 692-1205

Fax

(503) 692-1207

NPI assigned

Mar 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Silverton Health

  • Clinic/Center
  • Molalla, OR
  • NPI 1861116055
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279497600000",
    "number": "1932178951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 SW MORRISON ST",
            "address_2": "STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051945",
            "telephone_number": "503-242-9850",
            "fax_number": "503-279-8157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 SW 65TH AVE",
            "address_2": "STE 110",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627452",
            "telephone_number": "503-692-1205",
            "fax_number": "503-692-1207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMAN",
        "first_name": "JEFFREY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2010-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD13393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "282301",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fred Meyer Stores Inc
• Corona M Freitag, M.D.
• Fresenius Medical Care West Portland Dialysis Services, LLC
• Justin Friend, LMT
• Xinyu Steve Fu, M.D.
• Raelin Fullmer I
• Melissa Gaerisch, DPT
• Yessica Paulina Galeana
• Matthew S Galindo, ABA
• Jennifer S Gallardo, CPM

• Internal Medicine Physician in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.