Richard Fulroth, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25087 Issued in AZ

Practice address

550 E Washington Blvd
Crescent City, CA 95531-8160

Phone

(707) 465-6925

Fax

(707) 465-6070

NPI assigned

Sep 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Banner Estrella Medical Center

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1275566200
  NPD (past)
• Desert Valley Pediatrics

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1336354984
  NPD (past)

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1346236643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4137 N 108TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375459",
            "telephone_number": "623-877-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318160",
            "telephone_number": "707-465-6925",
            "fax_number": "707-465-6070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4137 N 108th Ave",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850375459",
            "country_code": "US",
            "telephone_number": "623-877-7337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULROTH",
        "first_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "OH",
            "license": "35041407",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "25087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0361513",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kiley Marie Ferreira
• Debra Courtney Foster, MSW
• Cindy J Fox, L.C.S.W.
• Callista Frye, PSYD
• Wendy Fullerton
• Function Junction Rehabilitation Center
• Cynthia Marie Gage
• Debra Gaines, RN
• Richelle M Gaiter, DMSC, PA
• Garfield Beach CVS LLC

• Pediatrics Physician in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; 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.