Individual
DOUGLAS CHARLES FULLERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 NW 12TH AVE, MIAMI, FL 33136-1003
(347) 875-0165
Mailing address
9440 BYRON AVE, SURFSIDE, FL 33154-2440
(347) 875-0165
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
608702
NY
367500000X
Certified Registered Nurse Anesthetist
608702
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9467663
FL
Other
Enumeration date
06/16/2014
Last updated
11/17/2021
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