Bryan Dale Fuller, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

E4442 Issued in AR

Practice address

625 United Dr Ste 220
Conway, AR 72032-7835

Phone

(501) 499-8300

Fax

(501) 379-8428

NPI assigned

Jun 7, 2006

Last updated

Jul 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DHP of Arkansas PA

  • Obstetrics & Gynecology Physician
  • Little Rock, AR
  • NPI 1992068878
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1487694790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 UNITED DR STE 330",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720327828",
            "telephone_number": "501-499-8300",
            "fax_number": "501-379-8428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 UNITED DR STE 220",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720327835",
            "telephone_number": "501-499-8300",
            "fax_number": "501-379-8428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "BRYAN",
        "middle_name": "DALE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "E4442",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AR",
            "license": "E4442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE/CROSS PROVIDER NO.",
            "identifier": "5N365",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Elise Fry
• James V Fudoli, MS
• Anni Julliett Fuenmayor, MS, PLD
• Shuhei Fukaya, LAT, ATC
• Karen Fulgham, ANP
• Dujuana Fuller, CMP
• Kayla Fuller, RD LD CLC
• Nichole Fuller
• Pamela Fuller, RECOVERY ASSISTANT
• Tammie Fuller, RECOVERY ASSISTANT

• Obstetrics & Gynecology Physician in Conway, AR
• Providers in Conway, AR by specialty
• Obstetrics & Gynecology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.