Philip S Fuller
Pediatrician Pediatric Emergency Physician
2727 E Southlake Blvd
Southlake
, Texas 76092-6613
Philip S Fuller
Pediatrician Pediatric Emergency Physician
2727 E Southlake Blvd
Southlake
, Texas 76092-6613
(682) 885-1396
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About
Features
Specialties
- Pediatric Emergency Physician
- Pediatrician
Languages spoken
- English
Location
First Address
- Philip S Fuller
- Po Box 99213
- Fort Worth, TX
- Zip : 76199-0213
- Fax : (682) 885-1396
- Phone : (682) 885-1860
Second Address
- Philip S Fuller
- 2727 E Southlake Blvd
- Southlake, TX
- Zip : 76092-6613
- Fax : (682) 885-6050
- Phone : (682) 885-6000
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207PP0204X | Pediatric Emergency Physician | E0922 | TX |
| Y | 208000000X | Pediatrician | E0922 | TX |
National Provider Identifier
| NPI | 1760592216 |
|---|---|
| Provider Name | Philip S Fuller |
| First Address | Fort Worth, TX 76199-0213 |
| Second Address | Southlake, TX 76092-6613 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/08/2006 |
| Last Update Date | 10/05/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| B22815 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.