Individual
DR. DANIEL RICHARDS FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1501
Mailing address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1501
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
M-12249
ID
2085R0202X
Diagnostic Radiology Physician
Primary
MD00049079
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0285030
L&I-RADIA REST OF WA
WA
01
—
0377759
L&I-RADIA KING COUNTY
WA
01
—
0377766
L&I-SWEDISH RADIA EDMONDS
WA
05
—
1054630
—
WA
05
—
1114994738
—
ID
01
—
4019715
BCBS
—
01
—
4102721
BCBS
—
Enumeration date
03/02/2006
Last updated
03/10/2025
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