Individual
ELBERT FULGRAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8134 MONTERRA RANCH DR APT 3622, FORT WORTH, TX 76177-6231
(480) 930-0459
Mailing address
8134 MONTERRA RANCH DR APT 3622, FORT WORTH, TX 76177-6231
(480) 930-0459
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
25298725
TX
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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