# COY FULLEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1902967243
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | BF4836978 | WA | — |
| 207Q00000X | Family Medicine Physician | O-0589 | ID | Yes |

## Other

- **Enumeration date:** 12/12/2006
- **Last updated:** 05/16/2018