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General NPI Number Information
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NPI Number | 1558443440
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Entity Type | Organization
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Legal Business Name | CHARLES L. FULBECK, M.D., INC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1551 BISHOP ST SUITE 420
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4635
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Country | US
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Telephone | 805-549-9533
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Fax | 805-549-8001
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Provider Business Mailing Address
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Address Line | PO BOX 25665
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City | SALT LAKE CITY
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State | UT
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Zip | 84125-0665
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Country | US
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Telephone | 805-549-9533
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Fax | 805-549-8001
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLES L. FULBECK
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Credential | MD
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Telephone | 805-549-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G50143
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License Number State | CA
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