MEDICARE: DR. GAY FULKERSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	30387	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080095920	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000051584	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1740395292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAY FULKERSON M.D.

Provider Business Mailing Address
First Line	:	310 S MAIN ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1428
Country	:	US
Telephone Number	:	270-259-9633
Fax Number	:	270-259-0061

Provider Business Practice Location Address
First Line	:	310 S MAIN ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1428
Country	:	US
Telephone Number	:	270-259-9633
Fax Number	:	270-259-0061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/12/2024

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