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NPI Code Detail

MEDICARE: MR. ROBERT SCOTT FULTON A.T.C

MEDICARE: MR. ROBERT SCOTT FULTON A.T.C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1417929084
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT SCOTT FULTON A.T.C
Provider Business Mailing Address
First Line : 112 PARKCREST CT
Second Line :
City : NOBLE
State : OK
Zip : 73068-9365
Country : US
Telephone Number : 405-872-7538
Fax Number :
Provider Business Practice Location Address
First Line : 180 W BROOKS ST
Second Line : RM. E-8
City : NORMAN
State : OK
Zip : 73019-1018
Country : US
Telephone Number : 405-325-8387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 07/08/2007

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