Provider Demographics
NPI:1396916680
Name:FULTON, MARCUS JEVON (NREMT-B)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:JEVON
Last Name:FULTON
Suffix:
Gender:M
Credentials:NREMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 WINTER GARDEN DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-3129
Mailing Address - Country:US
Mailing Address - Phone:318-221-0467
Mailing Address - Fax:
Practice Address - Street 1:964 WINTER GARDEN DR UNIT 1
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-3129
Practice Address - Country:US
Practice Address - Phone:318-221-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAB1595888146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic