Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 027003 | CT |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 027003 | CT |
NPI | 1154306462 |
---|---|
Provider Name | Dr. George F. Fuller |
First Address | Amherst, MA 01002-3039 |
Second Address | Leeds, MA 01053-9764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 17/07/2007 |