Provider Demographics
NPI:1770585994
Name:FULP, RAYMOND R III (DO)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:R
Last Name:FULP
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:REY TREY
Other - Middle Name:R
Other - Last Name:FULP
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:721 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2913
Mailing Address - Country:US
Mailing Address - Phone:956-668-7746
Mailing Address - Fax:956-668-8338
Practice Address - Street 1:721 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2913
Practice Address - Country:US
Practice Address - Phone:956-668-7746
Practice Address - Fax:956-668-8338
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7963207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201350018OtherTAX ID
TX129886107Medicaid
TX5197053OtherAETNA
TX142047100OtherVALLEY HEALTH PLANS
TX8H9770OtherBLUE CROSS BLUE SHIELD
TX200046413OtherRAILROAD MEDICARE
TX123586OtherCHIPS
TX046982702OtherCSHCN
TX4103818OtherBLUELINK
TXG03818Medicare UPIN
TX123586OtherCHIPS