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Individual

DR. TIMOTHY RICHARD FULLAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
240 W THOMAS RD # 400, PHOENIX, AZ 85013-4407
(602) 406-6262
(602) 406-6261
Mailing address
240 W THOMAS RD STE 301, PHOENIX, AZ 85013-4407
(602) 406-6262

Taxonomy

Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
Primary
73815
AZ
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
T1068
TX
2084N0400X
Neurology Physician
T1068
TX
208D00000X
General Practice Physician
28833
NE

Other

Enumeration date
04/15/2014
Last updated
02/05/2025
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