| NPI | 1427065580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER L FULTON President 618-654-9851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-09-11 |