Provider Demographics
NPI:1730138728
Name:FULCHER, DAVID ROBIN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBIN
Last Name:FULCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-0078
Mailing Address - Country:US
Mailing Address - Phone:970-375-6297
Mailing Address - Fax:970-385-1876
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:ANIMAS SURGICAL HOSPITAL
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-375-6297
Practice Address - Fax:970-385-1876
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7822207L00000X, 207LP2900X
TXJ2013207L00000X
CODR.0049896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06768OtherBLUE CROSS BLUE SHIELD FL
FL06768AMedicare PIN
FL06768OtherBLUE CROSS BLUE SHIELD FL
319174YVUXMedicare PIN