Fuller, Edward P

Fuller, Edward P is an individual health care provider with primary practice located at 101 Civic Center Lane , Lake Havasu City AZ 86403. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Fuller, Edward P can be contacted via phone (928) 453-3102.

Contact Information

Primary practice address
101 Civic Center Lane Lake Havasu City AZ 86403
Phone: (928) 453-3102
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 26880 Arizona
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X C50618 California

Profile Details

NPI number 1457454548
LBN Legal business name Fuller, Edward P
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457454548 NPPES
Arizona MEDICAID 523242

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