Individual
ANDREW DIXON FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4100 SUMMERHILL RD, TEXARKANA, TX 75503-2732
(903) 735-9802
(903) 735-9806
Mailing address
PO BOX 6228, TEXARKANA, TX 75505-6228
(903) 735-9802
(903) 735-9806
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
AP119199
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
R72921
AR
Other
Enumeration date
06/01/2010
Last updated
09/28/2023
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