Individual
MICHAEL P FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3009 N BALLAS RD STE 227A, SAINT LOUIS, MO 63131-2308
(314) 996-7800
Mailing address
3009 N BALLAS RD STE 227A, SAINT LOUIS, MO 63131-2308
(314) 996-7800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
106117
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205142003
—
MO
Enumeration date
08/02/2006
Last updated
02/11/2021
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