Individual
DR. CLINTON J FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9601 LILE DR, SUITE 1100, LITTLE ROCK, AR 72205-6321
(501) 227-5256
(501) 227-9151
Mailing address
9601 LILE DR, SUITE 1100, LITTLE ROCK, AR 72205-6321
(501) 227-5256
(501) 227-9151
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
C-5055
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109834001
—
AR
Enumeration date
05/19/2006
Last updated
01/19/2010
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