Individual
MR. KARL R FULLER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1275 ELM ST, WEST SPRINGFIELD, MA 01089-1820
(413) 785-1153
(413) 781-4951
Mailing address
1275 ELM ST, WEST SPRINGFIELD, MA 01089-1820
(413) 785-1153
(413) 781-4951
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1110
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M15170
BCBS
MA
Enumeration date
06/17/2006
Last updated
07/08/2007
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