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NPI Code Detail

MEDICARE: ANGELA FULTS DO

MEDICARE: ANGELA FULTS DO
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
1207Q00000XFamily Medicine PhysicianR9445IA

General Provider Information

NPI Number : 1689929507
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA FULTS DO
Provider Business Mailing Address
First Line : 300 W MAY ST STE A
Second Line :
City : MARENGO
State : IA
Zip : 52301-1261
Country : US
Telephone Number : 319-741-6789
Fax Number :
Provider Business Practice Location Address
First Line : 105 9TH AVE
Second Line :
City : BELLE PLAINE
State : IA
Zip : 52208-2200
Country : US
Telephone Number : 319-444-2840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2012
Last Update Date : 01/08/2020

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