Provider Demographics
NPI:1548240450
Name:FULMER, JOSEPH H III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:FULMER
Suffix:III
Gender:M
Credentials:CRNA
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 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:334-386-2051
Mailing Address - Fax:334-396-6929
Practice Address - Street 1:1000 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8703
Practice Address - Country:US
Practice Address - Phone:205-620-8948
Practice Address - Fax:205-620-7032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2024-01-31
Deactivation Date:2018-10-22
Deactivation Code:
Reactivation Date:2018-11-14
Provider Licenses
StateLicense IDTaxonomies
AL1-081452367500000X
AL1081452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531416Medicaid
AL051531416OtherBLUE CROSS BLUE SHIELD