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General NPI Number Information
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NPI Number | 1811028087
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Entity Type | Individual
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Provider Name | KURT B. FULK C. PED., BOC-O, CO
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2100 S BRENTWOOD BLVD STE A
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2534
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Country | US
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Telephone | 417-888-0887
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Fax |
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Provider Business Mailing Address
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Address Line | 638 SOMMER LN
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City | BILLINGS
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State | MO
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Zip | 65610-8324
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Country | US
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Telephone | 417-744-4152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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