Individual
WILLIAM ALLEN FULLER JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2212 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 572-8921
(434) 572-2063
Mailing address
2212 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 572-8921
(434) 572-2063
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101023878
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003685
BCBS
VA
01
—
16829
OPTIMA
VA
Enumeration date
03/14/2006
Last updated
07/08/2007
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