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FULLER DERMATOLOGY LLC
NPI 1083159529
Clinic/Center - Medical Specialty in South Pasadena, FL

Active since December 19, 2016
1609 PASADENA AVE S STE 4C, SOUTH PASADENA, FL 33707(727) 347-7524 Get Directions Write a Review

NPPES record last updated: August 29, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 29, 2018, Dec 19, 2016 (2 updates tracked since 2016).

About Fuller Dermatology Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FULLER DERMATOLOGY LLC (NPI 1083159529) is a healthcare organization registered as a medical specialty in South Pasadena, Florida and active in the NPI registry since December 2016. The organization lists Bruce W. Fuller, Owner, as its authorized official.

NPPES Registry Identity

NPI1083159529
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameFULLER DERMATOLOGY LLC
Location Address1609 PASADENA AVE S STE 4CSouth Pasadena, FL 33707
Mailing Address1609 Pasadena Ave S Ste 4cSouth Pasadena, FL 33707-4564
Phone(727) 347-7524
Organization SubpartNo
Authorized OfficialBruce W. FullerOwner · (727) 347-7524
Enumeration DateDecember 19, 2016
Last NPPES UpdateAugust 29, 20182 updates tracked since enumeration
✔ NPI 1083159529 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in FL · ME99153
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
1609 PASADENA AVE S STE 4C, South Pasadena, FL 33707
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fuller Dermatology LLC's NPI number?

The NPI number for Fuller Dermatology LLC is 1083159529. It was assigned to this organization in the NPPES registry on December 19, 2016.

Where is Fuller Dermatology LLC located?

Fuller Dermatology LLC is located at 1609 Pasadena Ave S Ste 4C, South Pasadena, FL 33707. The listed phone number is (727) 347-7524.

What is Fuller Dermatology LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

When was this NPI record last updated?

The NPPES record for Fuller Dermatology LLC was last updated on August 29, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.