Provider Demographics
NPI:1003069220
Name:FULLBRIGHT, CARL DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DUANE
Last Name:FULLBRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HANSEN DR
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-9753
Mailing Address - Country:US
Mailing Address - Phone:707-725-0335
Mailing Address - Fax:707-725-0335
Practice Address - Street 1:320 HANSEN DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-9753
Practice Address - Country:US
Practice Address - Phone:707-725-0335
Practice Address - Fax:707-725-0335
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE27636207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine