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NPI Code Detail

MEDICARE: DR. MARVIN CLARK FULTZ D.O.

MEDICARE: DR. MARVIN CLARK FULTZ 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
1207Q00000XFamily Medicine Physician8022MT
2207Q00000XFamily Medicine Physician1440WV
3207Q00000XFamily Medicine Physician5911AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750385340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVIN CLARK FULTZ D.O.
Provider Business Mailing Address
First Line : 519 E MAIN ST
Second Line :
City : CUT BANK
State : MT
Zip : 59427-3015
Country : US
Telephone Number : 406-873-5670
Fax Number : 406-873-2256
Provider Business Practice Location Address
First Line : 519 E MAIN ST
Second Line :
City : CUT BANK
State : MT
Zip : 59427-3015
Country : US
Telephone Number : 406-873-5670
Fax Number : 406-873-2256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 10/26/2010

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