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General NPI Number Information
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NPI Number | 1477851764
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Entity Type | Organization
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Legal Business Name | DAVID B. FULLER, D.O., P.C.
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 2004 MEDICAL CENTER DR
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City | BAY MINETTE
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State | AL
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Zip | 36507-4163
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Country | US
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Telephone | 251-937-7910
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Fax | 251-937-1846
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Provider Business Mailing Address
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Address Line | 2004 MEDICAL CENTER DR
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City | BAY MINETTE
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State | AL
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Zip | 36507-4163
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Country | US
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Telephone | 251-937-7910
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Fax | 251-937-1846
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID B. FULLER
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Credential | D.O.
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Telephone | 251-937-7910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO495
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License Number State | AL
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