Organization
BRUCE E. FULLER, M.D, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE EVANS FULLER M.D. (DERMATOLOGIST)
(757) 872-7787
Entity
Organization
Contact information
Practice address
12695 MCMANUS BLVD, BLDG 3, SUITE B, NEWPORT NEWS, VA 23602-4435
(757) 872-7787
(757) 872-7727
Mailing address
PO BOX 2579, NEWPORT NEWS, VA 23609-0579
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101045701
VA
Other
Enumeration date
07/18/2008
Last updated
07/18/2008
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