Individual
DR. BRIAN C FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2000 S THOMPSON ST, FLAGSTAFF, AZ 86001-8759
(928) 226-6400
(928) 226-6411
Mailing address
2000 S THOMPSON ST, FLAGSTAFF, AZ 86001-8759
(928) 226-6400
(928) 226-6411
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
3196
AZ
207RC0000X
Cardiovascular Disease Physician
Primary
3196
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
387953
—
AZ
Enumeration date
10/25/2006
Last updated
03/30/2009
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