Individual
DR. JOHN BRYANT FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5145 DEER PARK DR, NEW PORT RICHEY, FL 34653-7013
(904) 501-0083
Mailing address
PO BOX 874, PORT RICHEY, FL 34673-0874
(904) 501-0083
(727) 677-0286
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD2024-0084
NM
207XS0106X
Orthopaedic Hand Surgery Physician
ME155800
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD2024-0084
NM LICENSE
NM
Enumeration date
06/11/2015
Last updated
03/01/2024
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