Individual
TED FAULL
Active
Individual
TED FAULL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36082109
IL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
35.091967
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2890359
—
OH
Enumeration date
12/29/2005
Last updated
04/09/2024
Update your record
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