Individual
MR. PHILIP TOD FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MMS, BS, EMT-P
Contact information
Practice address
1411 S POTOMAC ST, SUITE 400, AURORA, CO 80012-4536
(303) 695-6060
(303) 369-7776
Mailing address
1411 S POTOMAC ST, SUITE 400, AURORA, CO 80012-4536
(303) 695-6060
(303) 369-7776
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2697
CO
Other
Enumeration date
10/24/2008
Last updated
10/24/2008
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