Fuller, Jonathan Ellis
Fuller, Jonathan Ellis is an individual health care provider with primary practice located at 13616 California St Ste 100, Omaha NE 68154-5335. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine, which is considered as his primary health care specialty. Fuller, Jonathan Ellis can be contacted via phone (402) 496-0404.Contact Information
Primary practice address
13616 California St Ste 100
Omaha NE 68154-5335
Phone: (402) 496-0404
Fax: (402) 496-0517
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine | 207XS0117X | 20813 | Nebraska |
Profile Details
NPI number | 1053314443 |
---|---|
LBN Legal business name | Fuller, Jonathan Ellis |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 31st, 2005 |
Last updated | Jan 28th, 2009 - about 16 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 | 1053314443 | NPPES |
Iowa | MEDICAID | 0511642 | |
Iowa | MEDICAID | 47081304012 | |
Iowa | Other | 07113 | |
Iowa | Other | 200031840 |
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