Individual
BRYAN H. FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 E RING RD, IRONTON, OH 45638-9610
(740) 534-9830
(740) 534-9832
Mailing address
1735 27TH ST STE B06, PORTSMOUTH, OH 45662-2681
(740) 356-8681
(740) 353-7900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35078023
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000380360
ANTHEM BCBS
KY
01
—
000000594108
ANTHEM BCBS
KY
01
—
000000634705
ANTHEM BCBS
KY
01
—
000000653707
ANTHEM BCBS
KY
05
—
2191453
—
OH
05
—
64022601
—
KY
Enumeration date
02/02/2006
Last updated
12/21/2020
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