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NPI Code Detail

MEDICARE: DR. GENE R FULLER MD

MEDICARE: DR. GENE R FULLER MD
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
1207Q00000XFamily Medicine Physician1786161205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396710281
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GENE R FULLER MD
Provider Business Mailing Address
First Line : 7181 S CAMPUS VIEW DR STE 200
Second Line :
City : WEST JORDAN
State : UT
Zip : 84084-4312
Country : US
Telephone Number : 801-965-3600
Fax Number :
Provider Business Practice Location Address
First Line : 999 MURRAY HOLLADAY RD
Second Line : SUITE 207
City : SALT LAKE CITY
State : UT
Zip : 84117-4901
Country : US
Telephone Number : 801-268-2584
Fax Number : 801-262-1168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 10/18/2022

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