MEDICARE: BEN E FULTON MD

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
1	247100000X	Radiologic Technologist	1499351205	UT

General Provider Information

NPI Number	:	1538304910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN E FULTON MD

Provider Business Mailing Address
First Line	:	130 S 400 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-1145
Country	:	US
Telephone Number	:	801-456-7226
Fax Number	:	801-456-7228

Provider Business Practice Location Address
First Line	:	130 S 400 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-1145
Country	:	US
Telephone Number	:	801-456-7226
Fax Number	:	801-456-7228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	12/12/2008

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