Individual
JOHN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 E CHERRY ST, TROY, MO 63379-1513
(636) 528-8551
Mailing address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
112096
MO
207Q00000X
Family Medicine Physician
112096
MO
Other
Enumeration date
06/06/2006
Last updated
04/21/2026
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