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Individual

DR. JONATHAN DANIEL FULLNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
350 W THOMAS RD, PHOENIX, AZ 85013-4409
(602) 406-7783
Mailing address
3901 PINE LAKE RD, LINCOLN, NE 68516-5497
(402) 420-3500

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
6773
NE
2085N0700X
Neuroradiology Physician
54143
AZ
2085R0202X
Diagnostic Radiology Physician
28782
NE
2085R0202X
Diagnostic Radiology Physician
Primary
54143
AZ

Other

Enumeration date
06/13/2012
Last updated
03/17/2018
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