Provider Demographics
NPI:1184703118
Name:FULCHER, BEVERLY CLAIRE (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:CLAIRE
Last Name:FULCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 FLOWOOD DR STE 303
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9306
Mailing Address - Country:US
Mailing Address - Phone:601-709-7700
Mailing Address - Fax:601-944-5551
Practice Address - Street 1:2550 FLOWOOD DR STE 303
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9306
Practice Address - Country:US
Practice Address - Phone:601-709-7700
Practice Address - Fax:601-944-5551
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16516207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00084891Medicaid
H91530Medicare UPIN
MS00084891Medicaid