| NPI | 1053447243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK J FULLMER Physician 480-889-7055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0484) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2007-12-13 |