Provider Demographics
NPI:1881231280
Name:FULFER, THOMAS DREW (COLO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DREW
Last Name:FULFER
Suffix:
Gender:M
Credentials:COLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3648
Mailing Address - Country:US
Mailing Address - Phone:580-699-8690
Mailing Address - Fax:580-699-8692
Practice Address - Street 1:804 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4209
Practice Address - Country:US
Practice Address - Phone:940-234-5347
Practice Address - Fax:580-699-8692
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist