Provider Demographics
NPI:1245508837
Name:STEPHANIE C FULTON, MD PA
Entity type:Organization
Organization Name:STEPHANIE C FULTON, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-880-2727
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:301
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-880-2727
Mailing Address - Fax:713-880-1643
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:301
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-880-2727
Practice Address - Fax:713-880-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9455207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX03161760O1Medicaid
TX1306982061OtherNPPES