Individual
ALAN FULLER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4050 COON RAPIDS BLVD, MERCY MEDICAL CENTER, COON RAPIDS, MN 55433
(763) 236-7144
(763) 236-7733
Mailing address
7301 OHMS LANE, SUITE 650, EDINA, MN 55439
(952) 835-9880
(952) 857-1554
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
32138
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32138
MN MEDICAL LICENSE
—
Enumeration date
03/18/2006
Last updated
07/08/2007
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