NPI Profile for Dr SAM FULLER in SOUTH BEND, IN.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Plastic and Reconstructive Surgery |
2086S0122X | 02 | Physician/General Surgery | |
Surgery of the Hand |
2086S0105X | 02 | Physician/General Surgery |
| NPI # | 1649569484 |
|
| Status | Active | |
| Credentials | MD | |
| Entity | Individual | |
| Enumeration date | 04/01/2011 | |
| Last updated | 09/03/2024 - More than a year ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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| Hospital affiliation(s) |
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SAM FULLER
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