Provider Demographics
NPI:1073689832
Name:FULMER, HUGH PRICE (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:PRICE
Last Name:FULMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15606
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-0606
Mailing Address - Country:US
Mailing Address - Phone:310-605-0128
Mailing Address - Fax:562-434-9184
Practice Address - Street 1:3628 E IMPERIAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2643
Practice Address - Country:US
Practice Address - Phone:310-605-0128
Practice Address - Fax:562-434-9189
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41467207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41467Medicare UPIN