Organization
FULLER DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE W. FULLER MD (OWNER)
(727) 347-7524
Entity
Organization
Contact information
Practice address
1609 PASADENA AVE S STE 4C, SOUTH PASADENA, FL 33707
(727) 347-7524
Mailing address
1609 PASADENA AVE S STE 4C, SOUTH PASADENA, FL 33707-4564
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
ME99153
FL
Other
Enumeration date
12/19/2016
Last updated
08/29/2018
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