Provider Demographics
NPI:1518939024
Name:FULLER, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:FULLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 S. MINNESOTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-12-11
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Provider Licenses
StateLicense IDTaxonomies
SD20802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN140M0FUOtherCC SYSTEMS/ BLUE PLUS
SD2080OtherDAKOTACARE
SD25065OtherARAZ/ AMERICA'S PPO
NE46022474352Medicaid
SD7100103Medicaid
SD14649OtherMIDLANDS CHOICE
IA1958108Medicaid
SD0040695OtherBLUE CROSS
ND12200Medicaid
MN394885400Medicaid
SD57108C008OtherWPS TRICARE
MN114837OtherUCARE
SD260051611OtherRR MEDICARE
SDHP24848OtherHEALTHPARTNERS
SD412991010162OtherPREFERRED ONE
SD23086OtherSANFORD HEALTH PLAN
SD23086OtherSANFORD HEALTH PLAN
MN140M0FUOtherCC SYSTEMS/ BLUE PLUS