Healthcare Provider Details

I. General information

NPI: 1467679886
Provider Name (Legal Business Name): CHARLES T FULMER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 E EXPOSITION AVE
AURORA CO
80012-2623
US

IV. Provider business mailing address

11586 E EVANS AVE
AURORA CO
80014-1158
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-7370
  • Fax:
Mailing address:
  • Phone: 303-614-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: