Michael D. Fulton, D.O., P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

J4130 Issued in TX

Legal business name

MICHAEL D. FULTON, D.O., P.A.

Practice address

3515 Shepherd LN
Balch Springs, TX 75180-2325

Phone

(972) 913-0200

Fax

(972) 913-8094

NPI assigned

Sep 14, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Michael Dwain Fulton, D.O.

Title

President

Phone

(972) 913-0200

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284422400000",
    "number": "1487962312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 SHEPHERD LN",
            "city": "BALCH SPRINGS",
            "state": "TX",
            "postal_code": "751802325",
            "telephone_number": "972-913-0200",
            "fax_number": "972-913-8094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 SHEPHERD LN",
            "city": "BALCH SPRINGS",
            "state": "TX",
            "postal_code": "751802325",
            "telephone_number": "972-913-0200",
            "fax_number": "972-913-8094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D. FULTON, D.O., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-14",
        "last_updated": "2010-09-14",
        "status": "A",
        "authorized_official_last_name": "FULTON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DWAIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-913-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J4130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285405-06",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285405-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; 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.