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General NPI Number Information
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NPI Number | 1992759054
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Entity Type | Organization
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Legal Business Name | CLAYTON G. FULLER MD, PC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1299 BERTHA HOWE AVE
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City | MESQUITE
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State | NV
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Zip | 89027-7500
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Country | US
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Telephone | 702-345-4270
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Fax |
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Provider Business Mailing Address
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Address Line | 2259 CASCADE CANYON DR
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City | ST GEORGE
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State | UT
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Zip | 84770-6263
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Country | US
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Telephone | 435-986-8154
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLAYTON G FULLER
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Credential | MD
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Telephone | 435-986-8154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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