Individual
LISA L FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4315 E MAIN ST, MESA, AZ 85205-8605
(480) 870-7500
(480) 906-2173
Mailing address
102 WOODMONT BLVD STE 600, NASHVILLE, TN 37205-5250
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
33576
AZ
Other
Enumeration date
03/20/2007
Last updated
08/08/2024
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