Individual
MR. JOHN ALLAN CLAYTON FULLING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2410 SAMPSON ST, FISHER BMC #237, GREAT LAKES, IL 60088
(847) 688-5556
(847) 688-2512
Mailing address
2524 N POPLAR ST, WAUKEGAN, IL 60087-3127
(619) 203-7508
(847) 688-2512
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/05/2008
Last updated
06/05/2008
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