Individual
DALLAS DAVARR FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
11800 ASTORIA BLVD, HOUSTON, TX 77089-6041
(713) 400-2990
(713) 400-2993
Mailing address
9525 KATY FWY STE 206, HOUSTON, TX 77024-1476
(713) 400-2990
(713) 400-2993
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
13-114322-121
KS
163W00000X
Registered Nurse
2011008339
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
AP145711
TX
Other
Enumeration date
03/24/2020
Last updated
03/27/2020
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