Individual
DALLAS FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
518 PEACHTREE RD, ORLANDO, FL 32804-6813
(407) 730-7983
Mailing address
844 CHAMBERLIN TRL, SAINT CLOUD, FL 34772-7750
(585) 435-1759
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/29/2021
Last updated
06/29/2021
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