Individual
DR. CHAD FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 PEACH ST STE A, SAN LUIS OBISPO, CA 93401-2871
(805) 543-4043
(805) 543-7640
Mailing address
1250 PEACH ST STE A, SAN LUIS OBISPO, CA 93401-2871
(805) 543-4043
(805) 543-7640
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A174124
CA
Other
Enumeration date
05/05/2018
Last updated
11/02/2023
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