Healthcare Provider Details

I. General information

NPI: 1104987817
Provider Name (Legal Business Name): THOMAS J. FULLER, MD, PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 SW 1ST AVE
OCALA FL
34474-4005
US

IV. Provider business mailing address

PO BOX 5457
OCALA FL
34478-5457
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-8311
  • Fax: 352-867-1053
Mailing address:
  • Phone: 352-867-8311
  • Fax: 352-867-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS J. FULLER
Title or Position: OWNER
Credential: M.D.
Phone: 352-867-8311