Provider Demographics
NPI:1144310459
Name:FULMER, ALISON (MD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:FULMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:FULMER
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8012 SE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8559
Mailing Address - Country:US
Mailing Address - Phone:503-771-2602
Mailing Address - Fax:
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-216-1880
Practice Address - Fax:503-216-1750
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16295207RC0000X
WAMD00034558207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease