Individual
MR. FREDERICK P FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-3004
(801) 581-2292
Mailing address
PO BOX 413033, SALT LAKE CITY, UT 84141-3033
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
018646
NY
363AM0700X
Medical Physician Assistant
Primary
9860440-1206
UT
Other
Enumeration date
06/14/2006
Last updated
01/13/2025
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