Individual
DR. BRIAN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 821-8038
(813) 974-0483
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
OS021622
PA
208000000X
Pediatrics Physician
Primary
OS21488
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124462300
—
FL
01
—
P8VF9
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/30/2018
Last updated
01/09/2025
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