Fuller, Keith Lyle
Fuller, Keith Lyle is an individual health care provider with primary practice located at 2214 Gateway Dr Suite C, Opelika AL 36801-1500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Fuller, Keith Lyle can be contacted via phone (334) 741-0075.Contact Information
Primary practice address
2214 Gateway Dr Suite C
Opelika AL 36801-1500
Phone: (334) 741-0075
Fax: (334) 741-4075
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | DO350 | Alabama |
Profile Details
| NPI number | 1730125527 |
|---|---|
| LBN Legal business name | Fuller, Keith Lyle |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2006 |
| Last updated | Mar 7th, 2023 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730125527 | NPPES |
| Alabama | Other | DO350 | MEDICAL LICENSE |
| Alabama | MEDICAID | 000026574 | MEDICAL LICENSE |
| Alabama | Other | 51026574 | MEDICAL LICENSE |
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