Individual
DR. DONALD RAY FULSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
306 E HOUSTON ST, TYLER, TX 75702-8218
(903) 593-6550
(903) 593-6554
Mailing address
306 E HOUSTON ST, TYLER, TX 75702-8218
(903) 593-6550
(903) 593-6554
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
L6047
TX
2084P0804X
Child & Adolescent Psychiatry Physician
L6047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158042501
—
TX
Enumeration date
09/14/2005
Last updated
05/14/2025
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