Individual
DR. DEAN ROY FULLINGIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
744 W 9TH ST, TULSA, OK 74127-9020
(918) 728-6194
(918) 664-2521
Mailing address
4500 S GARNETT RD, SUITE 919, TULSA, OK 74146-5229
(918) 728-6194
(918) 664-2521
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1610
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100093690A
—
OK
Enumeration date
11/02/2005
Last updated
03/28/2017
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