Provider Demographics
NPI:1588411573
Name:ASHLEY FULLER, MD PLLC
Entity type:Organization
Organization Name:ASHLEY FULLER, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-866-5148
Mailing Address - Street 1:633 YESLER WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2725
Mailing Address - Country:US
Mailing Address - Phone:206-866-5148
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON ST STE 1270
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3554
Practice Address - Country:US
Practice Address - Phone:206-866-5148
Practice Address - Fax:888-775-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center