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NPI Code Detail

MEDICARE: DWAIN FULLER M.D. .

MEDICARE: DWAIN 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
1207W00000XOphthalmology PhysicianD3227TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184623639
Entity Type Code : Individual
Provider Name (Legal Business Name) : DWAIN FULLER M.D. .
Provider Business Mailing Address
First Line : PO BOX 650037
Second Line :
City : DALLAS
State : TX
Zip : 75265-0037
Country : US
Telephone Number : 214-696-2008
Fax Number :
Provider Business Practice Location Address
First Line : 9600 N. CENTRAL EXPRESSWAY
Second Line : SUITE 100
City : DALLAS
State : TX
Zip : 75231-5078
Country : US
Telephone Number : 214-692-6941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 02/06/2013

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Directions to “ DWAIN FULLER M.D. .” Practice Location

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