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
Fax: (334) 741-4075
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730125527 NPPES
Alabama Other DO350 MEDICAL LICENSE
Alabama MEDICAID 000026574 MEDICAL LICENSE
Alabama Other 51026574 MEDICAL LICENSE

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