Individual
COY FULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
427 N 12TH ST, PLUMMER, ID 83851
(208) 686-1931
(208) 686-5133
Mailing address
PO BOX 388, PLUMMER, ID 83851-0388
(208) 686-1931
(208) 686-5133
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BF4836978
WA
207Q00000X
Family Medicine Physician
Primary
O-0589
ID
Other
Enumeration date
12/12/2006
Last updated
05/16/2018
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