Provider Demographics
NPI:1942259916
Name:DAVID R FULCHER, D.O., LLC
Entity Type:Organization
Organization Name:DAVID R FULCHER, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:FULCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-375-6297
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:970-247-0924
Mailing Address - Fax:970-385-1876
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:ANIMAS SURGICAL HOSPITAL ANESTHESIA DEPARTMENT
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:970-375-6297
Practice Address - Fax:970-385-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7822207L00000X
CODR.0049896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6459Medicare ID - Type Unspecified