Fuller, Maynard Darvy
Fuller, Maynard Darvy is an individual health care provider with primary practice located at 150 S Roadrunner Pkwy , Las Cruces NM 88011-7044. He recently has only one registered license in Allopathic & Osteopathic Physicians / Medical Oncology, which is considered as his primary health care specialty. Fuller, Maynard Darvy can be contacted via phone (505) 556-8600.Contact Information
Primary practice address
150 S Roadrunner Pkwy
Las Cruces NM 88011-7044
Phone: (505) 556-8600
Fax: (505) 556-8700
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Medical Oncology | 207RX0202X | 97239 | New Mexico |
| Allopathic & Osteopathic Physicians / Medical Oncology | 207RX0202X | G4000 | Texas |
Profile Details
| NPI number | 1679515589 |
|---|---|
| LBN Legal business name | Fuller, Maynard Darvy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2006 |
| Last updated | May 2nd, 2008 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679515589 | NPPES |
| New Mexico | MEDICAID | 000S2815 | |
| New Mexico | MEDICAID | 126330307 | |
| New Mexico | Other | 48753001 | |
| New Mexico | Other | 8R1442 | |
| New Mexico | MEDICAID | 126330301 | |
| New Mexico | MEDICAID | 140998901 |
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