Fuller, Jonathan Ellis

Fuller, Jonathan Ellis is an individual health care provider with primary practice located at 13616 California St Ste 100, Omaha NE 68154-5335. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine, which is considered as his primary health care specialty. Fuller, Jonathan Ellis can be contacted via phone (402) 496-0404.

Contact Information

Primary practice address
13616 California St Ste 100 Omaha NE 68154-5335
Phone: (402) 496-0404
Fax: (402) 496-0517
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine 207XS0117X 20813 Nebraska

Profile Details

NPI number 1053314443
LBN Legal business name Fuller, Jonathan Ellis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Jan 28th, 2009 - about 16 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 1053314443 NPPES
Iowa MEDICAID 0511642
Iowa MEDICAID 47081304012
Iowa Other 07113
Iowa Other 200031840

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