Fuller, Bryan Dale

Fuller, Bryan Dale is an individual health care provider with primary practice located at 625 United Dr Ste 220 , Conway AR 72032-7835. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Other Service Providers / Specialist. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Fuller, Bryan Dale can be contacted via phone (501) 499-8300.

Contact Information

Primary practice address
625 United Dr Ste 220 Conway AR 72032-7835
Phone: (501) 499-8300
Fax: (501) 379-8428
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X E4442 Arkansas
Other Service Providers / Specialist 174400000X E4442 Arkansas

Profile Details

NPI number 1487694790
LBN Legal business name Fuller, Bryan Dale
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 7th, 2006
Last updated Jul 8th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487694790 NPPES
Arkansas Other 5N365 BLUE/CROSS PROVIDER NO.

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