=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417952664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FALON D FULLER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14101 PARKWAY COMMONS DR
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73134-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-833-3378
-----------------------------------------------------
Fax | 405-758-5582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14101 PARKWAY COMMONS DR
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73134-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-833-3378
-----------------------------------------------------
Fax | 405-758-5582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 15286
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 15286
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------