Individual
CLARK J FULLMER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2615 FAIRWAY ST, DICKINSON, ND 58601
(701) 456-6000
Mailing address
2615 FAIRWAY ST, DICKINSON, ND 58601-2590
(701) 456-6000
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
60
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14953
—
ND
Enumeration date
01/24/2006
Last updated
08/30/2018
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