Fulton, Roger L

Fulton, Roger L is an individual health care provider with primary practice located at 1212 Broadway , Highland IL 62249-1960. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Fulton, Roger L can be contacted via phone (618) 654-9851.

Contact Information

Primary practice address
1212 Broadway Highland IL 62249-1960
Phone: (618) 654-9851
Fax: (618) 654-1339
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 36065210 Illinois
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 036065210 Illinois

Profile Details

NPI number 1972542488
LBN Legal business name Fulton, Roger L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Nov 6th, 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 1972542488 NPPES
Other 5828298 AETNA
Other 116583 AETNA
Other 52553 AETNA
Other 0403712 AETNA
Other 006015346 AETNA
MEDICAID 036065210 AETNA
Other 020011762 AETNA
Other 35030 AETNA

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