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NPI Code Detail

MEDICARE: JOHN ALAN FULLER M.D.

MEDICARE: JOHN ALAN FULLER M.D.
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
1207V00000XObstetrics & Gynecology Physician14299OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003816364
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN ALAN FULLER M.D.
Provider Business Mailing Address
First Line : 5101 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2018
Country : US
Telephone Number : 405-752-9600
Fax Number : 405-752-9650
Provider Business Practice Location Address
First Line : 5101 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2018
Country : US
Telephone Number : 405-752-9600
Fax Number : 405-752-9605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 05/14/2012

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