Individual
BRENT N FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
873 HULL RD UNIT 12, ORMOND BEACH, FL 32174
(386) 267-2965
(386) 603-6007
Mailing address
873 HULL RD UNIT 12, ORMOND BEACH, FL 32174
(386) 267-2965
(386) 603-6007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME94759
FL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
ME94759
FL
Other
Enumeration date
11/21/2005
Last updated
09/20/2024
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