MEDICARE: DAVID ROBIN FULCHER D.O.

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	207L00000X	Anesthesiology Physician	OS7822	FL
2	207L00000X	Anesthesiology Physician	J2013	TX
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	OS7822	FL
4	207L00000X	Anesthesiology Physician	DR.0049896	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06768	OTHER	FL	BLUE CROSS BLUE SHIELD FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730138728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBIN FULCHER D.O.

Provider Business Mailing Address
First Line	:	PO BOX 78
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81302-0078
Country	:	US
Telephone Number	:	970-375-6297
Fax Number	:	970-385-1876

Provider Business Practice Location Address
First Line	:	575 RIVERGATE
Second Line	:	ANIMAS SURGICAL HOSPITAL
City	:	DURANGO
State	:	CO
Zip	:	81301-7487
Country	:	US
Telephone Number	:	970-375-6297
Fax Number	:	970-385-1876

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/19/2015

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Directions to “ DAVID ROBIN FULCHER D.O.” Practice Location

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