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NPI Code Detail

MEDICARE: MICHAEL D. FULTON, D.O., P.A.

MEDICARE: MICHAEL D. FULTON, D.O., P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianJ4130TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487962312
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL D. FULTON, D.O., P.A.
Provider Business Mailing Address
First Line : 3515 SHEPHERD LN
Second Line :
City : BALCH SPRINGS
State : TX
Zip : 75180-2325
Country : US
Telephone Number : 972-913-0200
Fax Number : 972-913-8094
Provider Business Practice Location Address
First Line : 3515 SHEPHERD LN
Second Line :
City : BALCH SPRINGS
State : TX
Zip : 75180-2325
Country : US
Telephone Number : 972-913-0200
Fax Number : 972-913-8094
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHAEL DWAIN FULTON
Credential : D.O.
Telephone Number : 972-913-0200
Provider Enumeration Date : 09/14/2010
Last Update Date : 09/14/2010

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