| NPI | 1386808376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE EVANS FULLER Dermatologist 757-872-7787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101045701) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2008-07-18 |