Individual
DWAIN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D. .
Contact information
Practice address
9600 N. CENTRAL EXPRESSWAY, SUITE 100, DALLAS, TX 75231-5078
(214) 692-6941
Mailing address
PO BOX 650037, DALLAS, TX 75265-0037
(214) 696-2008
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
D3227
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129267407
—
TX
05
—
129267408
—
TX
05
—
129267409
—
TX
Enumeration date
07/18/2005
Last updated
02/06/2013
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