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Contact Information

LETA R FULLER, MD
4401 HARRISON BLVD
OGDEN, UT84403-3195
 Phone: 801-387-4300
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neonatal-Perinatal Medicine

2080N0001X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for LETA R FULLER · (Female)

NPI # 1982696159
Status Active
Credentials MD
Entity Individual
Enumeration date 08/16/2005
Last updated 05/19/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • OH License # 35073246
  • UT License # 6000865-1205
  • KY Medicaid 64060502
  • OH Medicaid 2140178
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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