Fullen, Jeryl Glynn

Fullen, Jeryl Glynn is an individual health care provider with primary practice located at 1101 Michigan Ave , Logansport IN 46947-1528. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Fullen, Jeryl Glynn can be contacted via phone (574) 753-1729.

Contact Information

Primary practice address
1101 Michigan Ave Logansport IN 46947-1528
Phone: (574) 753-1729
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 04-16478 Kansas
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 01063517A Indiana

Profile Details

NPI number 1275631020
LBN Legal business name Fullen, Jeryl Glynn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Jan 16th, 2014 - about 12 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 1275631020 NPPES
Indiana MEDICAID 200993900
Indiana Other 000000696600
Indiana Other 5N934
Indiana MEDICAID 100118960A

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