Maynard Darvy Fuller, M.D.

Primary specialty

Medical Oncology PhysicianTaxonomy code 207RX0202X

License

97239 Issued in NM

Practice address

150 S Roadrunner Pkwy
Las Cruces, NM 88011-7044

Phone

(505) 556-8600

Fax

(505) 556-8700

NPI assigned

Jun 12, 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 6

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.

• New Mexico Oncology Hematology Consultants, LTD.

  • Hematology & Oncology Physician
  • Albuquerque, NM
  • NPI 1164475232

  Medical Oncology

  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209686400000",
    "number": "1679515589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911230",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753911230",
            "telephone_number": "972-997-8000",
            "fax_number": "972-437-9605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S ROADRUNNER PKWY",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880117044",
            "telephone_number": "505-556-8600",
            "fax_number": "505-556-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MAYNARD",
        "middle_name": "DARVY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2008-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NM",
            "license": "97239",
            "primary": true
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "TX",
            "license": "G4000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000S2815",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126330307",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "48753001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF TEXAS",
            "identifier": "8R1442",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126330301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140998901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Fulford
• Andrew Paul Fulkerson, CRNA
• Hollyann Fulkerson, RN
• Full Bloom Pediatrics, LLC
• Gina M Fullbright, CNP
• Monica Anne Fullerton, LISW
• Function Therapy Specialists, Inc
• John Perry Funk, LISW
• Todd Funkhouser, M.D., PH.D
• Fyi Childrens Safehouse Cac

• Medical Oncology Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Medical Oncology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; 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.