Individual
DR. CLARK BEEMAN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8635 W 3RD ST, SUITE 975W, LOS ANGELES, CA 90048-6101
(310) 652-0530
(310) 652-9936
Mailing address
8635 W 3RD ST, SUITE 975W, LOS ANGELES, CA 90048-6101
(310) 652-0530
(310) 652-9936
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G76647
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
G76647
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0091070
—
CA
Enumeration date
08/21/2006
Last updated
04/19/2018
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