Provider Demographics
NPI:1962738690
Name:FULLER, JAMES DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:FULLER
Suffix:
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 1:22 JENKINS DR
Mailing Address - Street 2:HILLCREST ESTATES
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6526
Mailing Address - Country:US
Mailing Address - Phone:970-259-4833
Mailing Address - Fax:970-259-8193
Practice Address - Street 1:22 JENKINS DR
Practice Address - Street 2:HILLCREST ESTATES
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6526
Practice Address - Country:US
Practice Address - Phone:970-259-4833
Practice Address - Fax:970-259-8193
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO230892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology