Organization
ELITE SPORTS PODIATRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN WILLIAM FULLEM MD (MEDICAL DOCTOR/OWNER)
(203) 241-2582
Entity
Organization
Contact information
Practice address
1700 N MCMULLEN BOOTH RD, SUITE C-2, CLEARWATER, FL 33759-2130
(727) 330-7646
(727) 330-4645
Mailing address
1700 N MCMULLEN BOOTH RD STE C2, CLEARWATER, FL 33759-2129
(727) 330-7646
(727) 330-7645
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
PO3445
FL
Other
Enumeration date
09/23/2014
Last updated
01/07/2015
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