DR. MAYNARD DARVY FULLER M.D. NPI 1679515589

NPI Information

NPI: 1679515589
Provider Name: DR. MAYNARD DARVY FULLER, M.D.
Classification: Internal Medicine - 207RX0202X
Entity Type: Individual

Specialization: Medical Oncology

Address:
150 S ROADRUNNER PKWY
LAS CRUCES, NM
ZIP 88011
Phone: (505) 556-8600
Get Directions

DR. Maynard Darvy Fuller, M.D. is a medical oncology internal medicine in Las Cruces, NM. The provider is an internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. DR. Maynard Darvy Fuller, M.D. NPI is 1679515589. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

150 S ROADRUNNER PKWY
LAS CRUCES, NM
ZIP 88011-044
Phone: (505) 556-8600
Fax: (505) 556-8700

The enumeration date for this NPI number is 6/12/2006 and was last updated on 5/2/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RX0202X	Internal Medicine	Medical Oncology	G4000	TEXAS	No
2	207RX0202X	Internal Medicine	Medical Oncology	97239	NEW MEXICO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	126330307	MEDICAID	TEXAS
2	48753001	OTHER		CSHCN
3	P00173850	MEDICARE PIN	NEW MEXICO
4	D48266	MEDICARE UPIN	TEXAS
5	126330301	MEDICAID	TEXAS
6	8R1442	OTHER	TEXAS	BLUE CROSS OF TEXAS
7	8J0578	MEDICARE PIN	TEXAS
8	8366M1	MEDICARE PIN	TEXAS
9	140998901	MEDICAID	TEXAS
10	89941J	MEDICARE PIN	TEXAS
11	343408501	MEDICARE PIN	NEW MEXICO
12	000S2815	MEDICAID	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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