Individual provider · Type 1 NPI

Thomas Lance Fulghum, MD

Student in an Organized Health Care Education/Training Program · Green Bay, WI

NPI number 1760226716 Active

Practice location

3021 Voyager Dr
Green Bay, WI 54311-8303

Call (920) 431-1810 Map

Mailing address

PO Box 19070
Green Bay, WI 54307-9070

Specialties and licenses

TaxonomyCodeLicense
Family Medicine Physician 207Q00000X125-084945 (IL)
Student in an Organized Health Care Education/Training Program Primary 390200000X101347-851 (WI)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1760226716

Thomas Lance Fulghum, MD's National Provider Identifier is 1760226716, issued on Jun 24, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Green Bay, WI. The record was last updated on Jul 1, 2025.