Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Frederick P Fuller, PA-C

Individual provider Physician Assistant · NPI 1154364099

Mr. Frederick P Fuller, PA-C is a Physician Assistant in Salt Lake City, Utah. Licensed in New York and Utah. Registered with an NPI since 2006.

Licensed in
NY, UT
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

50 N Medical Dr
Salt Lake City, UT 84132-3004
Phone: (801) 581-2292
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 9860440-1206 (UT)
Physician Assistant Taxonomy 363A00000X · Licence 018646 (NY)

Record details

NPI number1154364099
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 14, 2006
Last updated in NPPESJanuary 13, 2025
Certification dateJanuary 13, 2025

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