Individual
MR. JOHN R FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 VINCENT ST, STEVENS POINT, WI 54481-1842
(715) 295-9939
Mailing address
500 VINCENT ST, STEVENS POINT, WI 54481-1842
(715) 295-9939
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
36770020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32166500
—
WI
01
—
P00069403
RAILROAD MEDICARE PROVIDER NUMBER
—
Enumeration date
07/21/2006
Last updated
12/29/2021
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