Provider Demographics
NPI:1750331104
Name:FULMER, BENJAMIN BANKS (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BANKS
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 1:806 ST. VINCENT'S DRIVE POB 4
Mailing Address - Street 2:SUITE 450
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-986-5200
Mailing Address - Fax:205-986-5250
Practice Address - Street 1:806 ST. VINCENT'S DRIVE 4
Practice Address - Street 2:SUITE 450
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-986-5200
Practice Address - Fax:205-986-5250
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18579207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942240Medicaid
ALG08215OtherSENIORS FIRST
ALG08215OtherHEALTH SPRING
AL051500940OtherUNITED HEALTH CARE
AL374211700OtherUS DEPT OF LABOR
AL51500940OtherBLUE CROSS AND BLUE SHIEL
AL51542406OtherBLUE CROSS
AL000093823Medicaid
AL051500940OtherBLUE ADVANTAGE
AL6151720001Medicare NSC
AL51542406OtherBLUE CROSS
AL051500940Medicare ID - Type Unspecified
140007443Medicare PIN