Provider Demographics
NPI:1740568526
Name:FULCHER, DEREK J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:J
Last Name:FULCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:350 W THOMAS RD SURGICAL SUITE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:602-406-3451
Mailing Address - Fax:602-406-7135
Practice Address - Street 1:350 W THOMAS RD SURGICAL SUITE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-406-3451
Practice Address - Fax:602-406-7135
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE6416207L00000X
AZ47867207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology