MEDICARE: DR. PATRICK J. FULLERTON D.O.

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	207P00000X	Emergency Medicine Physician	OS8087	FL
2	207Q00000X	Family Medicine Physician	OS8087	FL
3	208VP0000X	Pain Medicine Physician	OS8087	FL

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	OS8087	OTHER	FL	MEDICAL LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811039555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK J. FULLERTON D.O.

Provider Business Mailing Address
First Line	:	6909 OLD HIGHWAY 441 S STE 222
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7039
Country	:	US
Telephone Number	:	352-441-9803
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 OLD HIGHWAY 441 S STE 222
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7039
Country	:	US
Telephone Number	:	352-441-9803
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/12/2025

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Directions to “ DR. PATRICK J. FULLERTON D.O.” Practice Location

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