Rebecca L. Fulton, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

M-11363 Issued in ID

Practice address

415 6TH St
Pathologists' Regional Laboratory
Lewiston, ID 83501-2431

Phone

(208) 746-0516

Fax

(208) 746-4989

NPI assigned

Nov 15, 2007

Last updated

Oct 29, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414540800000",
    "number": "1093996365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "address_2": "PATHOLOGISTS' REGIONAL LABORATORY",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-746-0516",
            "fax_number": "208-746-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "address_2": "PATHOLOGISTS' REGIONAL LABORATORY",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-746-0516",
            "fax_number": "208-746-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "REBECCA",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-15",
        "last_updated": "2014-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "ID",
            "license": "M-11363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anatomic Pathology & Clinical Pathology Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Anatomic Pathology & Clinical Pathology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.