Provider Demographics
NPI:1083652564
Name:FULLER, BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:FULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4045 AVENUE B
Mailing Address - Street 2:SUITE 310W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1738
Mailing Address - Country:US
Mailing Address - Phone:406-651-9355
Mailing Address - Fax:406-651-8983
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 310W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6900
Practice Address - Fax:406-238-6939
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT10392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine