Fuller, Chuck B

Fuller, Chuck B is an individual health care provider with primary practice located at 660 Shoshone St E Suite 130, Twin Falls ID 83301-6110. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Fuller, Chuck B can be contacted via phone (208) 732-3400.

Contact Information

Primary practice address
660 Shoshone St E Suite 130 Twin Falls ID 83301-6110
Phone: (208) 732-3400
Fax: (208) 732-3300
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-499 Idaho

Profile Details

NPI number 1124015102
LBN Legal business name Fuller, Chuck B
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2005
Last updated Jan 10th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124015102 NPPES
Idaho Other 000010147741 REGENCE BLUE SHIELD IND #
Idaho Other PAQR4 REGENCE BLUE SHIELD IND #

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