Individual
DR. BRIAN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
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
Update your record
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