Provider Demographics
NPI:1447223003
Name:FULMER, ROBERT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:FULMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:PAUL
Other - Last Name:FULMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-689-4703
Mailing Address - Fax:877-647-0202
Practice Address - Street 1:7125 NEW SANGER AVE STE 504
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:254-655-3045
Practice Address - Fax:877-647-0202
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8055207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977009OtherTRICARE CHAMPUS
TX141087001Medicaid
TX5408023OtherAETNA
TXFU088866GOtherBCBS
TX117631OtherCHIPS
TX040015816OtherMEDICARE RAILROAD
TX8543M2Medicare ID - Type Unspecified
TX040015816Medicare PIN
TX5408023OtherAETNA