Brian G. Fuller, M.D.
in Coos Bay, OR. Individual provider (NPI-1).
NPI number1396834412
StatusActive
Last updated in NPPESDec 27, 2023
Details
- NPI
- 1396834412
- Entity type
- Individual (NPI-1)
- Name
- Brian G. Fuller
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 12, 2006
- Certification date
- Dec 27, 2023
- Last updated
- Dec 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0001X | MD186291 | OR | Yes | |
| 2085R0001X | 49432 | CO | ||
| 2085R0001X | MD2023-0362 | NM |
Practice location
1775 Thompson RdCoos Bay, OR 97420-2125
Phone 541-269-8520 · Fax 541-267-5083
Mailing address
1775 Thompson RdCoos Bay, OR 97420-2125
Phone 541-269-8520 · Fax 541-267-5083
Other practice locations
801 W Maple St
Farmington, NM 87401-5630
Farmington, NM 87401-5630
Phone 505-609-6259
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