Provider Demographics
NPI:1386786853
Name:FULLER, SIDNEY J (CCP)
Entity type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:J
Last Name:FULLER
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 N. INDIAN RUINS ST. C
Mailing Address - Street 2:PALO VERDE PERFUSION
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-885-8800
Mailing Address - Fax:520-885-2000
Practice Address - Street 1:6200 N. LA CHOLLA BLVD.
Practice Address - Street 2:NORTHWEST MEDICAL CENTER
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-742-9000
Practice Address - Fax:520-469-8591
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No171W00000XOther Service ProvidersContractor