Individual
MICHAEL FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15 S 1000 E, SUITE 200, PAYSON, UT 84651-5590
(801) 465-2800
Mailing address
15 S 1000 E, SUITE 200, PAYSON, UT 84651-5590
(801) 465-2800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
7192373-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497812721
—
UT
Enumeration date
09/13/2006
Last updated
03/08/2011
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