Healthcare Provider Details

I. General information

NPI: 1730267337
Provider Name (Legal Business Name): REGAN S. FULTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 N 34TH ST STE 100
SEATTLE WA
98103-8675
US

IV. Provider business mailing address

551 N 34TH ST STE 100
SEATTLE WA
98103-8675
US

V. Phone/Fax

Practice location:
  • Phone: 206-374-9000
  • Fax: 206-774-3412
Mailing address:
  • Phone: 206-374-9000
  • Fax: 206-774-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License NumberA65436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: