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Organization
EDWARD P FULLER MD PC
Active
Organization
EDWARD P FULLER MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD P FULLER MD (PRESIDENT)
(928) 854-5370
Entity
Organization
Contact information
Practice address
101 CIVIC CENTER LANE, LAKE HAVASU CITY, AZ 86403
(928) 854-5370
(928) 854-7942
Mailing address
PO BOX 1189, LAKE HAVASU CITY, AZ 86405
(928) 854-5370
(928) 854-7942
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
26880
AZ
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
C50618
CA
Other
Enumeration date
02/15/2008
Last updated
02/15/2008
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