Individual
MR. MICHAEL W. FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7000 W PLANO PKWY, SUITE 200, PLANO, TX 75093-8466
(214) 483-9300
(214) 483-9301
Mailing address
7000 W PLANO PKWY, SUITE 200, PLANO, TX 75093-8466
(214) 483-9300
(214) 483-9301
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA02147
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201918401
—
TX
Enumeration date
12/01/2006
Last updated
09/16/2009
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