RICHARD E FULLER MD NPI 1306841002

NPI Information

NPI: 1306841002
Provider Name: RICHARD E FULLER, MD
Classification: Family Medicine - 207QA0505X
Entity Type: Individual

Specialization: Adult Medicine

Organization: RAE HOLDINGS LTD

PECOS Registration: Yes

Address:
17780 VERSAILLES CT
BROOKFIELD, WI
ZIP 53045
Phone: (262) 389-1375
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Richard E Fuller, MD is an adult medicine family medicine in Brookfield, WI with 36 years of experience. The provider is definition to come. Richard E Fuller, MD NPI is 1306841002. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
Graduation Year:1988

The provider's business location address is:

17780 VERSAILLES CT
BROOKFIELD, WI
ZIP 53045-026
Phone: (262) 389-1375

The NPI 1306841002 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/17/2005 and was last updated on 6/11/2021.

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	207QA0505X	Family Medicine	Adult Medicine	32988-020	WISCONSIN	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	1306841002	OTHER	WISCONSIN	BCBS
2	31875900	MEDICAID	WISCONSIN
3	208000000X	MEDICAID	WISCONSIN

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: 11/14/2023

NPI Synchronization or Removal

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