Organization
DAVID B. FULLER, D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID B. FULLER D.O. (PRESIDENT)
(251) 937-7910
Entity
Organization
Contact information
Practice address
2004 MEDICAL CENTER DR, BAY MINETTE, AL 36507-4163
(251) 937-7910
(251) 937-1846
Mailing address
2004 MEDICAL CENTER DR, BAY MINETTE, AL 36507-4163
(251) 937-7910
(251) 937-1846
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO495
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000077277
MEDICARE ID
AL
05
—
000077277
—
AL
01
—
0005495200
AETNA
AL
01
—
080174991
PALMETTO GBA - RAILROAD MEDICARE
AL
01
—
51077277
BLUECROSS/BLUESHIELD
AL
Enumeration date
03/10/2011
Last updated
03/10/2011
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