Individual
DR. MARK A FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1251 S HICKORY ST, MELBOURNE, FL 32901-3221
(321) 434-3420
(321) 434-3423
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1981
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
ME105861
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001679400
—
FL
01
—
CS864X
MEDICARE
FL
01
—
CS864Y
MEDICARE
FL
Enumeration date
07/01/2005
Last updated
08/31/2017
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