Edward P Fuller, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

26880 Issued in AZ

Practice address

101 Civic Center Lane
Lake Havasu City, AZ 86403

Phone

(928) 453-3102

NPI assigned

Sep 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edward P Fuller MD PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Lake Havasu City, AZ
  • NPI 1588832208
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457454548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864051189",
            "telephone_number": "928-854-5370",
            "fax_number": "928-854-7942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CIVIC CENTER LANE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-453-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "EDWARD",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": "26880",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "C50618",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "523242",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan D Freiberg, LAC
• Frontier Wellness, LLC
• Katelyn Marie Frost, PHARMD
• Alisha M Fulker, P.T., DPT
• Allison Nicole Fuller
• Maria Fuller, CRNA
• David Funk, PT, DPT
• Melissa Christine Funk, HIS
• Allison Joy Fuoco
• Ashley Gagnon

• Anatomic Pathology & Clinical Pathology Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Anatomic Pathology & Clinical Pathology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.