Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25870 | NE |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036144916 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | R8564 | TX |
NPI | 1396972386 |
---|---|
Provider Name | Dr. Brian C Fuller |
First Address | Carrollton, TX 75010-4615 |
Second Address | Carrollton, TX 75010-4615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 29/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8LJ360 | BCBS (01) | TX |