Individual
DR. JOHN CARR FULLERTON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1901 S 1ST ST, GENERAL SURGERY SVC-112, TEMPLE, TX 76504-7451
(254) 778-4811
Mailing address
1407 INDIAN TRL, SALADO, TX 76571-5492
(254) 947-5976
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101031485
VA
208600000X
Surgery Physician
E0099
AR
208600000X
Surgery Physician
Primary
G2136
TX
Other
Enumeration date
08/15/2006
Last updated
07/08/2007
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