Fullam, Timothy Richard
Fullam, Timothy Richard is an individual health care provider with primary practice located at 3551 Roger Brooke Dr , Jbsa Ft Sam Houston TX 78234-4504. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neuromuscular Medicine, Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Fullam, Timothy Richard can be contacted via phone (210) 916-2203.Contact Information
Primary practice address
3551 Roger Brooke Dr
Jbsa Ft Sam Houston TX 78234-4504
Phone: (210) 916-2203
Fax: (210) 916-2203
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neuromuscular Medicine | 2084N0008X | T1068 | Texas |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 28833 | Nebraska |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | T1068 | Texas |
Profile Details
| NPI number | 1952720104 |
|---|---|
| LBN Legal business name | Fullam, Timothy Richard |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 15th, 2014 |
| Last updated | Jul 18th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952720104 | NPPES |
| Texas | MEDICAID | 19552780104 |
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