Individual
MICHAEL A FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 UNIVERSITY BLVD, GALVESTON, TX 77555-0190
(409) 747-9722
(409) 747-8367
Mailing address
2122 AVENUE K, GALVESTON, TX 77550-4645
(409) 939-9409
(409) 747-8367
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
H6226
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139588114
CIDC TPI
TX
Enumeration date
05/25/2006
Last updated
09/13/2012
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