Individual
DANIEL RAYMOND FULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1200 CEDAR CT, CARBONDALE, IL 62901-5334
(618) 529-8500
Mailing address
1200 CEDAR CT, CARBONDALE, IL 62901-5334
(618) 529-8500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036.128075
IL
Other
Enumeration date
07/03/2006
Last updated
06/15/2011
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