Provider Demographics
NPI:1295779353
Name:FULCHER, WILLIAM LEWIS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEWIS
Last Name:FULCHER
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 1:8919 HIGHWAY 119 STE 102
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-5329
Mailing Address - Country:US
Mailing Address - Phone:205-624-3605
Mailing Address - Fax:205-449-8870
Practice Address - Street 1:8919 HIGHWAY 119 STE 102
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-5329
Practice Address - Country:US
Practice Address - Phone:205-624-3605
Practice Address - Fax:205-449-8870
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36296207QA0505X
IL036129102207QA0505X
AL11090207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036129102OtherLICENSE
ALMD.11090OtherMEDICAL LICENSE
AZ36296OtherLICENSE
AL009985835Medicaid
AL051035000OtherBLUE CROSS
ALA160326983OtherMEDICARE PTAN