Individual
DR. COLIN M FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2385 E PRATER WAY, SUITE 302, SPARKS, NV 89434-9629
(775) 356-4514
(775) 356-4991
Mailing address
PO BOX 3046, MALVERN, PA 19355-0746
(775) 356-4514
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
3987
NV
207RC0000X
Cardiovascular Disease Physician
G26986
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11040349
CAQH
—
01
—
1578555165
NPI
—
01
—
3987
MEDICAL LICENSE
NV
01
—
G26986
MEDICAL LICENSE
CA
Enumeration date
08/18/2005
Last updated
05/08/2018
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