Individual
RONALD FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949
Mailing address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32081
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0187187
—
IA
01
—
1187187
MEDICAID IOWA W/ ORA
IA
01
—
20765
BCBS OF IOWA W/ ORA
IA
01
—
300095837
RR MDC FOR RGPCSC
—
01
—
300121312
RAILROAD MEDICARE W/ ORA
IA
01
—
300132299
RR MDC FOR RGIC LLC
—
01
—
32985
BCBS IA FOR RGPCSC
—
05
—
4187487
—
IA
01
—
49669
BCBS IA FOR RGIC LLC
—
01
—
K51666
MEDICARE FOR ORA
IA
Enumeration date
03/24/2006
Last updated
05/05/2021
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