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DR. DONALD RAY FULSOM M.D. NPI 1679568794


NPI Information

NPI: 1679568794
Provider Name: DR. DONALD RAY FULSOM, M.D.
Classification: Psychiatry & Neurology - 2084P0802X
Entity Type: Individual

Specialization: Addiction Psychiatry

PECOS Registration: Yes

Address:
401 E FRONT ST
TYLER, TX
ZIP 75702
Phone: (903) 593-6550
Get Directions

DR. Donald Ray Fulsom, M.D. is an addiction psychiatry psychiatry neurology in Tyler, TX. The provider is addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. DR. Donald Ray Fulsom, M.D. NPI is 1679568794. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

401 E FRONT ST
TYLER, TX
ZIP 75702-213
Phone: (903) 593-6550
Fax: (903) 593-6554

The NPI 1679568794 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/14/2005 and was last updated on 6/18/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0802XPsychiatry & NeurologyAddiction PsychiatryL6047TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H85841MEDICARE UPINTEXAS
215804250MEDICAIDTEXAS
300903HMEDICARE ID-TYPE UNSPECIFIEDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.