Provider Demographics
NPI:1811287816
Name:FULLER, JOSEPH C III (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:FULLER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3861
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10700 E GEDDES AVE STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3861
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-010802085R0202X
NE299412085R0202X
KS04-398282085R0202X
390200000X
CO581552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO581760YQ33OtherMEDICARE PIN
CO581760YQN9OtherMEDICARE PIN
KS111257106OtherMEDICARE PIN
KSKA3249097OtherMEDICARE PIN
NENA1217018OtherMEDICARE PIN
CO581760YQPGOtherMEDICARE PIN
CO581760ZLJ3OtherMEDICARE PIN
CO581760ZNTBOtherMEDICARE PIN
NENA1214119OtherMEDICARE PIN
NENA1215120OtherMEDICARE PIN
CO1811287816Medicaid
KS111257106OtherMEDICARE PIN
NENA1217018OtherMEDICARE PIN