Individual
DR. DOUGLAS L FULK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 CEDAR CT, CARBONDALE, IL 62901-5334
(618) 529-8500
(618) 549-1000
Mailing address
PO BOX 969, ATTN: DEBBIE STRAUSS, CARBONDALE, IL 62903-0969
(314) 821-8055
(314) 821-1833
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036091745
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091745-1
—
IL
Enumeration date
12/13/2005
Last updated
03/09/2011
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