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Organization

PRIME SURGICAL ASSISTING, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY TRENT FULLMER PA-C (OWNER)
(480) 216-2231
Entity
Organization

Contact information

Practice address
2905 W WARNER RD STE 1, CHANDLER, AZ 85224-1674
(480) 603-9000
Mailing address
3760 E COTTON CT, GILBERT, AZ 85234-4330
(480) 216-2231

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
P-1257205-6
AZ

Other

Enumeration date
05/23/2006
Last updated
03/27/2018
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