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Individual

DR. EDWARD P FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
101 CIVIC CENTER LANE, LAKE HAVASU CITY, AZ 86403
(928) 453-3102
Mailing address
PO BOX 1189, LAKE HAVASU CITY, AZ 86405-1189
(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

Other identifiers
Code
Description
Identifier
Issuer
State
05
523242
AZ
Enumeration date
09/06/2006
Last updated
07/08/2007
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