Fullard, Jasper

Fullard, Jasper is an individual health care provider with primary practice located at 5746 N Broadway St , Kansas City MO 64118-3998. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Fullard, Jasper can be contacted via phone (816) 912-4539.

Contact Information

Primary practice address
5746 N Broadway St Kansas City MO 64118-3998
Phone: (816) 912-4539
Fax: (855) 813-6642
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 04-16758 Kansas
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X R7174 Missouri
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X 04-16758 Kansas
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X R7174 Missouri

Profile Details

NPI number 1770523540
LBN Legal business name Fullard, Jasper
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2006
Last updated Jul 10th, 2014 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770523540 NPPES
Kansas MEDICAID 100093400F

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