Individual
DR. SAMUEL EDWARD FULLER
Active
Individual
DR. SAMUEL EDWARD FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
04-41647
KS
2085R0202X
Diagnostic Radiology Physician
23277
NE
2085R0202X
Diagnostic Radiology Physician
Primary
43466
CO
2085R0202X
Diagnostic Radiology Physician
7318A
WY
2085R0202X
Diagnostic Radiology Physician
A72891
CA
2085R0202X
Diagnostic Radiology Physician
MD19873
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111257122
MEDICARE
KS
01
—
638284AE6Y
MEDICARE
CO
01
—
638284YQ33
MEDICARE
CO
01
—
638284YQN9
MEDICARE
CO
01
—
638284YQPG
MEDICARE
CO
01
—
638284ZLJ3
MEDICARE PTAN
CO
01
—
650671
MEDICARE
CO
05
—
88153746
—
CO
01
—
KA3249113
MEDICARE
KS
01
—
NA1214128
MEDICARE PTAN
NE
01
—
NA1215129
MEDICARE PTAN
NE
01
—
NA2517106
MEDICARE PTAN
NE
Enumeration date
07/13/2006
Last updated
12/09/2022
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