Individual
DR. DOUGLAS CONRAD FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., MPH
Contact information
Practice address
4311 CARSWELL AVE BLDG 340, NELLIS AFB, NV 89191-7069
(702) 653-3431
(702) 653-3591
Mailing address
4811 CARSWELL DR. BLDG 340, NELLIS AFB, NV 89191
(702) 653-3431
(702) 653-3591
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
18972
NV
2083X0100X
Occupational Medicine Physician
Primary
18972
NV
2083X0100X
Occupational Medicine Physician
358526-1205
UT
Other
Enumeration date
10/13/2005
Last updated
08/03/2023
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