Provider Demographics
NPI:1285708172
Name:FULTON, WILLIAM FOWLER JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FOWLER
Last Name:FULTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:321 S RED ROCK ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1957
Mailing Address - Country:US
Mailing Address - Phone:480-813-6624
Mailing Address - Fax:
Practice Address - Street 1:2557 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6229
Practice Address - Country:US
Practice Address - Phone:480-917-7546
Practice Address - Fax:623-234-2543
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22294207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF36991Medicare UPIN