Individual
BRANDON JOSEPH FULPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
6828 SE HOLGATE BLVD, PORTLAND, OR 97206-3504
(971) 803-8290
Mailing address
3181 NE 23RD ST APT F127, GRESHAM, OR 97030-4316
(971) 381-7561
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
24CRM3393
OR
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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