Provider Demographics
NPI:1518921469
Name:FOULLON, RICHARD ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:FOULLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3217 SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1737
Mailing Address - Country:US
Mailing Address - Phone:818-957-0808
Mailing Address - Fax:818-957-8113
Practice Address - Street 1:544 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3311
Practice Address - Country:US
Practice Address - Phone:818-241-4331
Practice Address - Fax:818-241-2253
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-30779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG30779DMedicare ID - Type Unspecified
CAA44544Medicare UPIN