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1154364099
FREDERICK P FULLER
SALT LAKE CITY, UT
NPI
1154364099
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: UT 9860440-1206)
Enumeration Date
2006-06-14
Last Update Date
2021-12-10
Business Address
Mr. FREDERICK P FULLER PA-C
50 N MEDICAL DR
SALT LAKE CITY, UT 84132-3004
Phone number: 801-581-2292
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Mailing Address
Mr. FREDERICK P FULLER PA-C
PO BOX 413033
SALT LAKE CITY, UT 84141-3033
Phone number:
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