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NPI Code Detail

MEDICARE: TERRY WAYNE FULLER M.D.

MEDICARE: TERRY WAYNE 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
12084N0400XNeurology PhysicianK0759TX

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 : 1669481453
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY WAYNE FULLER M.D.
Provider Business Mailing Address
First Line : 2121 PEASE ST STE 2C
Second Line :
City : HARLINGEN
State : TX
Zip : 78550-8321
Country : US
Telephone Number : 956-440-7494
Fax Number : 956-440-8301
Provider Business Practice Location Address
First Line : 2121 PEASE ST STE 2C
Second Line :
City : HARLINGEN
State : TX
Zip : 78550-8321
Country : US
Telephone Number : 956-440-7494
Fax Number : 956-440-8301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/08/2007

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Directions to “ TERRY WAYNE FULLER M.D.” Practice Location

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