Individual
STEPHEN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16001 QUARRY RD, LAKE OSWEGO, OR 97035-3359
(503) 635-1055
Mailing address
16001 QUARRY RD, LAKE OSWEGO, OR 97035-3359
(503) 635-1055
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD15877
OR
Other
Enumeration date
03/12/2008
Last updated
03/12/2008
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