Healthcare Provider Details

I. General information

NPI: 1346521887
Provider Name (Legal Business Name): JAMES WESLEY FULTON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD 350
FORT COLLINS CO
80528-3400
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-2370
  • Fax: 970-221-9654
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberDR.0056855
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: