Individual
GABE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4801 E LINWOOD BLVD, KANSAS CITY, MO 64128-2226
(816) 861-4700
Mailing address
4801 E LINWOOD BLVD, KANSAS CITY, MO 64128-2226
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
T-03158
KS
Other
Enumeration date
02/01/2012
Last updated
02/01/2012
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