Marvin Clark Fultz, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

8022 Issued in MT

Practice address

519 E Main St
Cut Bank, MT 59427-3015

Phone

(406) 873-5670

Fax

(406) 873-2256

NPI assigned

Jun 10, 2005

Last updated

Oct 26, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tanana Chiefs Conference

  • Ambulatory Surgical Clinic/Center
  • Fairbanks, AK
  • NPI 1871332387
  NPD (past)

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288051200000",
    "number": "1750385340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 E MAIN ST",
            "city": "CUT BANK",
            "state": "MT",
            "postal_code": "594273015",
            "telephone_number": "406-873-5670",
            "fax_number": "406-873-2256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 E MAIN ST",
            "city": "CUT BANK",
            "state": "MT",
            "postal_code": "594273015",
            "telephone_number": "406-873-5670",
            "fax_number": "406-873-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTZ",
        "first_name": "MARVIN",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2010-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "8022",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1440",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "5911",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0038726",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD6852",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cut Bank School District
• Daniel Depinto
• Debra Erin Devries, RDH
• Tina R Dion, LMT
• Drugmart Inc (Drugmart Pharmacy)
• Nancy Lynn Gilbert, LMT
• Hoang Girgen, PHARMD
• Glacier Care Center, Inc. (Glacier Care Center)
• Glacier Community Health Center Inc
• Glacier Community Pharmacy

• Family Medicine Physician in Cut Bank, MT
• Providers in Cut Bank, MT by specialty
• Family Medicine Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.