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Individual

DR. STANLEY BRIAN FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2825 LYNDHURST AVE, STE 101, WINSTON SALEM, NC 27103-4146
(336) 277-4075
(336) 277-4095
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 277-4075
(336) 277-4095

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
34605
NC
208C00000X
Colon & Rectal Surgery Physician
Primary
34605
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1437119302
VA
01
34605
NC LLICENSE
NC
05
8934129
NC
Enumeration date
03/24/2006
Last updated
07/03/2023
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