MEDICARE: ADAM MICHAEL FULLER PA-C

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
1	363AS0400X	Surgical Physician Assistant	PA15203	TX

General Provider Information

NPI Number	:	1730847450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM MICHAEL FULLER PA-C

Provider Business Mailing Address
First Line	:	1870 ENGLISH RD
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75032-8290
Country	:	US
Telephone Number	:	214-558-6857
Fax Number	:

Provider Business Practice Location Address
First Line	:	422 S HILLCREST DR
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-3661
Country	:	US
Telephone Number	:	903-885-2820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	12/04/2024

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