Organization
FULMER AND JOHNSON FOOT & ANKLE , P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAIL R. JOHNSON D.P.M. (PHYSICIAN/SECRETARY AND TREASURER)
(479) 582-1199
Entity
Organization
Contact information
Practice address
2828 E MILLENNIUM PL, FAYETTEVILLE, AR 72703-6514
(479) 582-1199
(479) 582-1194
Mailing address
2828 E MILLENNIUM PL, FAYETTEVILLE, AR 72703-6514
(479) 582-1199
(479) 582-1194
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161082748
—
AR
05
—
200098510A
—
OK
01
—
5F602
BLUE SHIELD
AR
Enumeration date
07/10/2006
Last updated
02/19/2008
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