Individual
MR. JOHN A FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 E CHESTNUT AVE, PONCA CITY, OK 74601-4311
(580) 763-0931
(580) 763-0934
Mailing address
3542 SPRINGWOOD ST, APT. 604, PONCA CITY, OK 74604-1632
(580) 716-1731
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
NONE
—
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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