Individual
PHILLIP TYLER FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1414 ARLINGTON STREET, SUITE 2300, ADA, OK 74820
(580) 332-0112
(580) 332-1005
Mailing address
1414 ARLINGTON STREET, SUITE 2300, ADA, OK 74820
(580) 332-0112
(580) 332-1005
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
30483
OK
Other
Enumeration date
06/11/2009
Last updated
06/25/2014
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