Douglas Conrad Fuller, M.D., MPH

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

18972 Issued in NV

Practice address

4311 Carswell Ave BLDG 340
Nellis Afb, NV 89191-7069

Phone

(702) 653-3431

Fax

(702) 653-3591

NPI assigned

Oct 13, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1649268533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 CARSWELL DR. BLDG 340",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "89191",
            "telephone_number": "702-653-3431",
            "fax_number": "702-653-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 CARSWELL AVE BLDG 340",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891917069",
            "telephone_number": "702-653-3431",
            "fax_number": "702-653-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "DOUGLAS",
        "middle_name": "CONRAD",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "NV",
            "license": "18972",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "UT",
            "license": "358526-1205",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NV",
            "license": "18972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stone Frankford, MD
• Marquesz Anthony Franks
• Yasmin Freckleon, CADC
• Tina Marie Frisch, PHARM.D.
• Jennifer Fuentes
• Robert E Fuller, DDS
• Noah L. Furr, M.D.
• Sara Hope Gaarde, APRN
• Sidney A Gabaldon, LCSW
• Mackenzie Lauren Gabler, M.D.

• Occupational Medicine Physician in Nellis Afb, NV
• Providers in Nellis Afb, NV by specialty
• Occupational Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; 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.