Basic Information
| Provider Information | |||||||||
| NPI: | 1750331104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FULMER | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | BANKS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 ST. VINCENT'S DRIVE POB 4 | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059865200 | ||||||||
| FaxNumber: | 2059865250 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 ST. VINCENT'S DRIVE 4 | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059865200 | ||||||||
| FaxNumber: | 2059865250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 18579 | AL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 009942240 | 05 | AL | MEDICAID | G08215 | 01 | AL | SENIORS FIRST | OTHER | G08215 | 01 | AL | HEALTH SPRING | OTHER | 051500940 | 01 | AL | UNITED HEALTH CARE | OTHER | 374211700 | 01 | AL | US DEPT OF LABOR | OTHER | 51500940 | 01 | AL | BLUE CROSS AND BLUE SHIEL | OTHER | 51542406 | 01 | AL | BLUE CROSS | OTHER | 000093823 | 05 | AL | MEDICAID | 051500940 | 01 | AL | BLUE ADVANTAGE | OTHER |