Provider Demographics
NPI:1316054117
Name:FULLER, STEVEN B (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:FULLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1908 CHEROKEE AVE SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5502
Mailing Address - Country:US
Mailing Address - Phone:256-734-4700
Mailing Address - Fax:256-736-1458
Practice Address - Street 1:1908 CHEROKEE AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5502
Practice Address - Country:US
Practice Address - Phone:256-734-4700
Practice Address - Fax:256-736-1458
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO711207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51510407OtherBLUECROSS/BLUESHIELD
AL7993241OtherAETNA
AL737638OtherCCN
AL051510407Medicaid