Provider Demographics
NPI:1265412480
Name:FULLER-EDDINS, TAMARA N (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:N
Last Name:FULLER-EDDINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:2805 DODD RD STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2160
Practice Address - Country:US
Practice Address - Phone:651-241-7733
Practice Address - Fax:651-241-0258
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200101202207V00000X
CO46990207V00000X
SD9163207V00000X
MN58931207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology