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Individual

DR. EARL W FULLER JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
102 FAIRVIEW DR, SUITE E, FRANKLIN, VA 23851-1226
(757) 562-0383
(757) 962-1254
Mailing address
205 BUSINESS PARK DRIVE, SUITE 200, VIRGINIA BEACH, VA 23462-6335
(757) 962-1083
(757) 962-1254

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101019245
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
005848067
VA
01
33684
OPTIMA HEALTH PLAN
VA
01
398492
MAMSI
VA
01
433816
ANTHEM BC/BS AND HKP
VA
05
89063U1
NC
Enumeration date
06/06/2006
Last updated
10/30/2008
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