Fuller Dermatology LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

ME99153 Issued in FL

Legal business name

FULLER DERMATOLOGY LLC

Practice address

1609 Pasadena Ave S Ste 4C
South Pasadena, FL 33707

Phone

(727) 347-7524

NPI assigned

Dec 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bruce W. Fuller, MD

Title

Owner

Phone

(727) 347-7524

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Arnold Erwin Ison, MD

  • Dermatology Physician
  • St Pete Beach, FL
  • NPI 1023113636
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535500800000",
    "number": "1083159529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 PASADENA AVE S STE 4C",
            "city": "SOUTH PASADENA",
            "state": "FL",
            "postal_code": "337074564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 PASADENA AVE S STE 4C",
            "city": "SOUTH PASADENA",
            "state": "FL",
            "postal_code": "33707",
            "telephone_number": "727-347-7524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-19",
        "last_updated": "2018-08-29",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-347-7524",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "ME99153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Florida Accident & Injury, Inc
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• Florida United Radiology, LC
• Cornelius Shaw Franckle, M.D.
• Galen of Florida, Inc
• Mohamed Gamal-Eldin, DDS
• Wayne J Garcia, MD
• Haley Goldin
• Filip Grdic, DDS

• All providers in South Pasadena, FL
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.