Individual
DR. COLIN WYATT FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 STANTON L YOUNG BLVD # 1400, OKLAHOMA CITY, OK 73104-5018
(405) 271-5504
Mailing address
800 STANTON L YOUNG BLVD, OKLAHOMA CITY, OK 73104-5018
(405) 271-5504
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
6781
GA
207YP0228X
Pediatric Otolaryngology Physician
Primary
67805
OK
Other
Enumeration date
06/24/2014
Last updated
11/09/2021
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