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General NPI Number Information
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NPI Number | 1508867672
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Entity Type | Individual
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Provider Name | WAYNE TEMPLETON FULLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 628 THALIA POINT RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1816
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Country | US
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Telephone | 757-672-8367
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Fax |
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Provider Business Mailing Address
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Address Line | 628 THALIA POINT RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1816
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Country | US
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Telephone | 757-672-8367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0101034109
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31285
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38697
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19181
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 339571-1205
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License Number State | UT
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G084432
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26099
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License Number State | AZ
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00035725
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License Number State | WA
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37054
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License Number State | CO
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 99-44
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License Number State | NM
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Taxonomy #11
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6222A
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License Number State | WY
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Taxonomy #12
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 42646
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License Number State | MN
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Taxonomy #13
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D56565
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License Number State | MD
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Taxonomy #14
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-8300
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License Number State | ID
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Taxonomy #15
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | VT
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