Provider Demographics
NPI:1306982061
Name:FULTON, STEPHANIE CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CAROL
Last Name:FULTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:301
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-880-2727
Mailing Address - Fax:
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:301
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-880-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9455207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10015566OtherAMERIGROUP
TX00A09POtherBLUE CROSS
TX00A09POtherBLUE CROSS