Individual
LETA R FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4401 HARRISON BLVD, OGDEN, UT 84403-3195
(801) 387-4300
Mailing address
324 E 10TH AVE STE 172, SLC, UT 84103-2884
(801) 408-5155
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
35073246
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
6000865-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2140178
—
OH
05
—
64060502
—
KY
Enumeration date
08/16/2005
Last updated
05/19/2024
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