Individual
PAUL DAVID FULLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4937
(815) 398-9491
(815) 381-7498
Mailing address
PO BOX 735263, CHICAGO, IL 60673-5263
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036-106473
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106473
—
IL
Enumeration date
12/12/2006
Last updated
02/06/2023
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