Healthcare Provider Details

I. General information

NPI: 1548213119
Provider Name (Legal Business Name): THOMAS WAYNE FULBRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W 74TH ST STE 2
SHAWNEE MISSION KS
66204-2201
US

IV. Provider business mailing address

8901 W 74TH ST STE 2
SHAWNEE MISSION KS
66204-2201
US

V. Phone/Fax

Practice location:
  • Phone: 913-261-2222
  • Fax: 913-261-2229
Mailing address:
  • Phone: 913-261-2222
  • Fax: 913-261-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008009944
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2008009944
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0421442
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0421422
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: