Provider Demographics
NPI:1891016408
Name:WILLIAM E. FULLER M.D., P.C.
Entity Type:Organization
Organization Name:WILLIAM E. FULLER M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-320-1227
Mailing Address - Street 1:1601 E 19TH AVE STE 5100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1254
Mailing Address - Country:US
Mailing Address - Phone:303-320-1227
Mailing Address - Fax:303-320-1235
Practice Address - Street 1:1601 E 19TH AVE STE 5100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1254
Practice Address - Country:US
Practice Address - Phone:303-320-1227
Practice Address - Fax:303-320-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15707207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01157072Medicaid
CO95025545Medicaid
COC32471Medicare PIN
COD22907Medicare UPIN