Leta R Fuller, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

6000865-1205 Issued in UT

Practice address

4401 Harrison Blvd
Ogden, UT 84403-3195

Phone

(801) 387-4300

NPI assigned

Aug 16, 2005

Last updated

May 19, 2024By the provider in NPPES

Sex

Female

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Academic Association, Inc.

  • Pediatrics Physician
  • Columbus, OH
  • NPI 1063419943
  NPD (past)

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716076800000",
    "number": "1982696159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 E 10TH AVE STE 172",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841032884",
            "telephone_number": "801-408-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 HARRISON BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033195",
            "telephone_number": "801-387-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 W Layton Pkwy",
            "address_purpose": "LOCATION",
            "city": "Layton",
            "state": "UT",
            "postal_code": "840413692",
            "country_code": "US",
            "telephone_number": "801-507-2404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "LETA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-16",
        "last_updated": "2024-05-19",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "UT",
            "license": "6000865-1205",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "OH",
            "license": "35073246",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2140178",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64060502",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Taylor Frost, MD
• Ivanna Maria Fuentes Javier
• Naoya Fujii
• Anna G Fuller, DMD
• Heather Fuller
• Robin Fullmer
• Shinae Furgeson
• Jaden Furniss
• Abigail Fuscone
• Kyle Fusselman, D.O.

• Neonatal-Perinatal Medicine Physician in Ogden, UT
• Providers in Ogden, UT by specialty
• Neonatal-Perinatal Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2024; 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.