Provider Demographics
NPI:1063659662
Name:FULLER, CHRISTOPHER SHAWN
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SHAWN
Last Name:FULLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13280 NORTHWEST FWY
Mailing Address - Street 2:SUITE F391
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6029
Mailing Address - Country:US
Mailing Address - Phone:713-906-4455
Mailing Address - Fax:281-516-0161
Practice Address - Street 1:19515 STAMFORD DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-0904
Practice Address - Country:US
Practice Address - Phone:832-882-9228
Practice Address - Fax:281-516-0161
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator