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NPI Code Detail

MEDICARE: ALLIE MARIE FULLER M.D.

MEDICARE: ALLIE MARIE 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
1208000000XPediatrics PhysicianN5681TX
2208M00000XHospitalist PhysicianN5681TX

General Provider Information

NPI Number : 1942461454
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLIE MARIE FULLER M.D.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6684 W ADAMS AVE
Second Line :
City : TEMPLE
State : TX
Zip : 76502-5632
Country : US
Telephone Number : 254-899-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2008
Last Update Date : 12/08/2021

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