Individual
BRIAN C FULKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201
(208) 232-1443
(208) 239-3434
Mailing address
1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201
(208) 232-1443
(208) 239-3434
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-10672
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808342900
—
ID
Enumeration date
02/04/2008
Last updated
03/17/2025
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