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NPI Code Detail

MEDICARE: BRUCE W. FULLER M.D.

MEDICARE: BRUCE W. FULLER M.D.
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
1207N00000XDermatology Physician19252NV

General Provider Information

NPI Number : 1588861397
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE W. FULLER M.D.
Provider Business Mailing Address
First Line : 640 W MOANA LN
Second Line :
City : RENO
State : NV
Zip : 89509-4903
Country : US
Telephone Number : 775-324-0699
Fax Number : 775-323-6814
Provider Business Practice Location Address
First Line : 640 W MOANA LN
Second Line :
City : RENO
State : NV
Zip : 89509-4903
Country : US
Telephone Number : 775-324-0699
Fax Number : 775-323-6814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2007
Last Update Date : 01/21/2026

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Directions to “ BRUCE W. FULLER M.D.” Practice Location

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