Healthcare Provider Details

I. General information

NPI: 1093030918
Provider Name (Legal Business Name): JAMES R FULMER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2010
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 DENISON ST
CONWAY AR
72034-6127
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-1325
  • Fax: 501-327-1328
Mailing address:
  • Phone: 501-327-1325
  • Fax: 501-327-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-7992
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: