# DR. MARVIN CLARK FULTZ

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750385340
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1440 | WV | — |
| 207Q00000X | Family Medicine Physician | 5911 | AK | — |
| 207Q00000X | Family Medicine Physician | 8022 | MT | Yes |

## Other

- **Enumeration date:** 06/10/2005
- **Last updated:** 10/26/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0038726 | — | MT |
| 05 | — | MD6852 | — | AK |