Individual
DR. DALE EUGENE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12221 MERIT DRIVE, #500, DALLAS, TX 75251
(972) 490-2900
(972) 386-0261
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 437-9605
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
D4659
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139559201
—
TX
05
—
139559202
—
TX
01
—
139559203
CSHCN
TX
05
—
139559204
—
TX
05
—
139559205
—
TX
05
—
139559206
—
TX
05
—
139559207
—
TX
05
—
139559208
—
TX
05
—
139559210
—
TX
05
—
139559211
—
TX
05
—
139559212
—
TX
05
—
139559214
—
TX
01
—
8R1441
BLUE CROSS OF TX
TX
Enumeration date
07/20/2006
Last updated
06/20/2008
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