Individual
MATTHEW FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301094972
MI
208800000X
Urology Physician
35125792
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC2433
MEDICARE RR
OH
Enumeration date
07/17/2009
Last updated
06/19/2015
Update your record
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