GARY TRENT FULLMER


Address: 485 S Dobson Rd Ste 110, Chandler, AZ 85224
Phone: 4807284470

GARY TRENT FULLMER (NPI# 1427008150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1427008150
Entity Type Individual
Full Name GARY TRENT FULLMER
Credential P.A.-C
Practice Address 485 S Dobson Rd Ste 110
Chandler
AZ 85224
Mailing Address 3030 N Central Ave Ste 1001
Phoenix
AZ 85012-2716
Practice Telephone 4807284470
Practice Fax Number 4807284499
Mailing Telephone 6024064786
Mailing Fax Number 9166364358
Enumeration Date 2006-05-11
Last Update Date 2019-07-22
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
2774 AZ Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
DEA MF0957893 01
AZ PHYSICIAN ASSISTANT LICEN 2774 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
475 S Dobson Rd, Chandler, AZ 852245605 4805072961 4805072971

Office Location

Street Address 485 S DOBSON RD STE 110
City CHANDLER
State AZ
Zip Code 85224

Providers in the same location

NPI Name Taxonomy Address Enumeration
1386604767 Miguel A. Pirela-cruz Orthopaedic Surgery 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 2006-03-28
1417435181 Ellayna Wiedow Physician Assistant 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 2018-08-03
1275052664 Christian Andreen Physician Assistant 485 S Dobson Rd Ste 110, Chandler, AZ 85224 2017-09-17
1417316449 Joby K Janardhanan Nurse Practitioner 485 S Dobson Rd Ste 110, Chandler, AZ 85224 2016-02-18
1396116992 Vanessa Gordon Physician Assistant 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 2015-10-08
1356683924 Ammar Karim Orthopaedic Surgery 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 2013-03-21
1215215678 Emily Cha Orthopaedic Surgery 485 S Dobson Rd Ste 110, Chandler, AZ 85224 2011-08-02
1073846176 Jamie Jennette Coracides Physician Assistant 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 2009-09-08
1386847226 Benjamin L. Geer Orthopaedic Surgery 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 2007-06-07
1578775748 Roland D Benigno Physician Assistant 485 S Dobson Rd Ste 110, Chandler, AZ 85224 2007-05-03
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1245878859 Optum Infusion Services 308, LLC Durable Medical Equipment & Medical Supplies 460 S. Benson Lane, Ste. 11-12, Chandler, AZ 85224 2019-12-13
1073172037 Brennan Allen Dentist 610 N Alma School Rd Ste 4, Chandler, AZ 85224 2019-06-12
1518525237 Rachel Kelly Mador-house Genetic Counselor, MS 685 & 695 S Dobson Rd, Chandler, AZ 85224 2019-05-29
1780249748 Julia Solomon, Md Obstetrics & Gynecology 1725 West Frye Road, Suite 120, Chandler, AZ 85224 2019-05-06
1487118717 Litonrx LLC Pharmacy 2080 N. Dobson Road, Suite 3, Chandler, AZ 85224 2019-01-31
1528556495 Stone Med, LLC Physical Medicine & Rehabilitation 77 S Dobson Rd., Phoenix, AZ 85224 2018-04-26
1144739079 Four Peaks Anesthesia Consultants, LLC Anesthesiology 1900 W Chandler Blvd Ste 15-257, Chandler, AZ 85224 2017-09-22
1275061350 Whitney Carter Behavioral Analyst 3200 N Dobson Rd Ste F-1, Chandler, AZ 85224 2017-06-01
1528509171 Angela M. Navarrete Specialist/Technologist, Other 1586 W Maggio Way Apt 2005, 2005, Chandler, AZ 85224 2017-03-15
1063958288 Glover Family Medical, LLC Clinic/Center 901 S Alma School Rd, Apt. 20, Chandler, AZ 85224 2017-01-11
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1528439965 Amici Surgical Assistants Physician Assistant 123 W Chandler Heights Rd Unit 13132, Chandler, AZ 85248-1087 2015-10-12
1932527108 John Proctor Physician Assistant 1210 W Shawnee Dr, Chandler, AZ 85224-2369 2014-04-03
1720237431 Advanced Surgical Assistants LLC Physician Assistant 2074 E Honeysuckle Pl, Chandler, AZ 85286-2315 2008-09-17
1528013364 Prime Surgical Assisting, LLC Physician Assistant 2905 W Warner Rd Ste 1, Chandler, AZ 85224-1674 2006-05-23
1356305890 Christabelle N Wong Physician Assistant 975 E Riggs Rd, Suite 12-268, Chandler, AZ 85249-4260 2006-04-13
1629032206 Delia Bautista Tobin Physician Assistant 1538 E Fairview St, Chandler, AZ 85225-2222 2006-04-12
1861491706 Brian E Hertel Physician Assistant 4424 E Virgo Pl, Chandler, AZ 85249-5898 2005-07-21
1417435181 Ellayna Wiedow Physician Assistant 485 S Dobson Rd Ste 110, Chandler, AZ 85224-5600 2018-08-03
1679091920 Shane Joseph Ewalt Physician Assistant 525 S Chandler Village Dr, Chandler, AZ 85226-5069 2017-09-07
1922419191 Advanced Surgical Physician Assistants, LLC Physician Assistant 2925 E Riggs Rd, Suite 8-114, Chandler, AZ 85249-3600 2014-05-09
Find all providers in CHANDLER

Competitor

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City CHANDLER
Zip Code 85224

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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