Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3543 | CA |
Y | 222Z00000X | Podiatrist | E3543 | CA |
N | 2081S0010X | Sports Medicine | E3543 | CA |
N | 213ES0000X | Sports Medicine | E3543 | CA |
NPI | 1346234457 |
---|---|
Provider Name | Dr. Eric Arthur Fuller |
First Address | Albany, CA 94706-2515 |
Second Address | Berkeley, CA 94706-2245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 17/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BBB80382B | EDI SUBMITTER NUMBER (01) | CA |
U80754 | (02) | CA |