Individual
DR. CHARLES W FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1933 PINE ST, STE B, ABILENE, TX 79601-2431
(325) 675-0338
(325) 676-5049
Mailing address
1933 PINE ST, STE B, ABILENE, TX 79601-2431
(325) 675-0338
(325) 676-5049
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
F3971
TX
207Q00000X
Family Medicine Physician
Primary
F3971
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113131101
FIRST CARE HMO
TX
05
—
140117607
—
TX
05
—
140117624
—
TX
Enumeration date
06/27/2005
Last updated
08/04/2011
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