| Name: | David B. Fuller, D.O., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 24 Oct 1997 (27 years ago) (Companies founded in October 1997) |
| Date of dissolution: | 19 Dec 2011 |
| Entity Number: | 000-191-098 |
| Register Number: | 000191098 |
| ZIP code: | 36507 (Companies in Baldwin, 36507) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | BAY MINETTE, AL |
| Registered Office Street Address: | 611 MIXON AVEBAY MINETTE, AL 36507 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PRACTICE OSTEOPATHY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477851764 | 2011-03-10 | 2011-03-10 | 2004 MEDICAL CENTER DR, BAY MINETTE, AL, 365074163, US | 2004 MEDICAL CENTER DR, BAY MINETTE, AL, 365074163, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 251-937-7910 |
| Fax | 2519371846 |
Authorized person
| Name | DAVID B. FULLER |
| Role | PRESIDENT |
| Phone | 2519377910 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | DO495 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PALMETTO GBA - RAILROAD MEDICARE |
| Number | 080174991 |
| State | AL |
| Issuer | BLUECROSS/BLUESHIELD |
| Number | 51077277 |
| State | AL |
| Issuer | AETNA |
| Number | 0005495200 |
| State | AL |
| Issuer | MEDICARE ID |
| Number | 000077277 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000077277 |
| State | AL |
| Name | Role |
|---|---|
| FULLER, DAVID B | Agent |
| Name | Role |
|---|---|
| FULLER, DAVID B | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
