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Individual
COY FULLEN
Active
Individual
COY FULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BF4836978
WA
207Q00000X
Family Medicine Physician
Primary
O-0589
ID
Other
Enumeration date
12/12/2006
Last updated
05/16/2018
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