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1003827601
JEFFERY FULLER
MONROE, LA
NPI
1003827601
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207P00000X Emergency Medicine
(Licence: LA 018474)
Enumeration Date
2006-08-10
Last Update Date
2007-07-08
Business Address
-- JEFFERY FULLER M.D.
4864 JACKSON ST DEPARTMENT OF EMERGENCY MEDICAL SERVICES
MONROE, LA 71202-6400
Phone number: 318-675-7737
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Mailing Address
-- JEFFERY FULLER M.D.
1501 KINGS HWY MANAGED CARE
SHREVEPORT, LA 71103
Phone number: 318-675-7737
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