Individual
DR. PATRICK J. FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6909 OLD HIGHWAY 441 S STE 222, MOUNT DORA, FL 32757-7039
(352) 441-9803
Mailing address
6909 OLD HIGHWAY 441 S STE 222, MOUNT DORA, FL 32757-7039
(352) 441-9803
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
OS8087
FL
207Q00000X
Family Medicine Physician
OS8087
FL
208VP0000X
Pain Medicine Physician
Primary
OS8087
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015379100
—
FL
01
—
OS8087
MEDICAL LICENSE NUMBER
FL
Enumeration date
02/12/2007
Last updated
08/12/2025
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