EDWARD P FULLER MD PC (NPI# 1588832208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588832208 |
| Entity Type | Organization |
| Organization Name | EDWARD P FULLER MD PC |
| Practice Address |
101 Civic Center Lane Lake Havasu City AZ 86403 |
| Mailing Address |
Po Box 1189 Lake Havasu City AZ 86405 |
| Practice Telephone | 9288545370 |
| Practice Fax Number | 9288547942 |
| Mailing Telephone | 9288545370 |
| Mailing Fax Number | 9288547942 |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-15 |
| Authorized Official Name | DR. EDWARD P FULLER (PRESIDENT) |
| Authorized Official Telephone | 9288545370 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
C50618 | CA | Allopathic & Osteopathic Physicians |
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
26880 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 523242 | 05 |
| Street Address |
101 CIVIC CENTER LANE |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457454548 | Edward P Fuller | Pathology | 101 Civic Center Lane, Lake Havasu City, AZ 86403 | 2006-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457454548 | Edward P Fuller | Pathology | 101 Civic Center Lane, Lake Havasu City, AZ 86403 | 2006-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881200632 | Eric David Peters | Pathology | 11545 E Quiet Valley Pl, Tucson, AZ 85749-8884 | 2020-09-17 |
| 1609434794 | Peak Diagnostic Services LLC | Pathology | 3033 N 44th St Ste 200, Phoenix, AZ 85018-7244 | 2019-06-03 |
| 1144638008 | Michael Moore | Pathology | 8796 N Western Red Cedar Dr, Tucson, AZ 85743-7146 | 2014-07-23 |
| 1356683155 | Belinda Liu Sun | Pathology | 1501 N Campbell Ave Rm 5205, Tucson, AZ 85724-7232 | 2013-03-20 |
| 1669717815 | Guadalupe Hortencia Manriquez | Pathology | 7601 N Calle Sin Envidia, 31, Tucson, AZ 85718-1271 | 2012-11-29 |
| 1407164486 | Aztec Pathology LLC | Pathology | 2538 E University Dr Ste 100, Phoenix, AZ 85034-6925 | 2010-09-23 |
| 1336471846 | Peter Salomon | Pathology | 6344 E Miramar Dr, Tucson, AZ 85715-3115 | 2010-02-08 |
| 1427387372 | Meryl Harold Haber | Pathology | 8464 E Charter Oak Dr, Scottsdale, AZ 85260-5315 | 2009-12-23 |
| 1538492400 | Paul Boschen Visconti | Pathology | 33619 N 79th Way, Scottsdale, AZ 85266-4241 | 2009-09-10 |
| 1417186305 | Brent J Bedke | Pathology | 1740 Sycamore Ave Ste C, Kingman, AZ 86409-1039 | 2009-07-13 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.