Dr Thomas Lance Fulghum, MD is a
Student In An Organized Health Care Education/training Program physician based in Green Bay, Wisconsin. Dr Thomas Lance Fulghum is licensed to practice in Wisconsin (license number 101347-851) and his current practice location is 3021 Voyager Dr, Green Bay, Wisconsin. He can be reached at his office (for appointments etc.) via phone at
(920) 431-1810.
NPI number for Dr Thomas Lance Fulghum is 1760226716 and his current mailing address is Po Box 19070, Green Bay, Wisconsin. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1760226716.
Physician's Profile
| Full Name | Dr Thomas Lance Fulghum |
|---|
| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 3021 Voyager Dr, Green Bay, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1760226716
- Provider Enumeration Date: 06/24/2024
- Last Update Date: 07/01/2025
Medical Identifiers
Medical identifiers for Dr Thomas Lance Fulghum such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1760226716 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 125-084945 (Illinois) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | 101347-851 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Thomas Lance Fulghum is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Thomas Lance Fulghum, MD
Po Box 19070,
Green Bay, WI 54307-9070
Ph: (920) 431-1810 | Dr Thomas Lance Fulghum, MD
3021 Voyager Dr,
Green Bay, WI 54311-8303
Ph: (920) 431-1810 |
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