Individual
PAUL G FULLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
90 PRESIDENTIAL PLZ, 3RD FLOOR, SYRACUSE, NY 13202-2240
(315) 464-4357
(315) 464-2030
Mailing address
90 PRESIDENTIAL PLZ, 3RD FLOOR, SYRACUSE, NY 13202-2240
(315) 464-4357
(315) 464-2030
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
122518
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00382150
—
NY
Enumeration date
07/18/2006
Last updated
09/14/2012
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