Individual
JOHN ALAN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5101 W MEMORIAL RD, OKLAHOMA CITY, OK 73142-2018
(405) 752-9600
(405) 752-9605
Mailing address
5101 W MEMORIAL RD, OKLAHOMA CITY, OK 73142-2018
(405) 752-9600
(405) 752-9650
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
14299
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100824640B
—
OK
Enumeration date
07/28/2005
Last updated
05/14/2012
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