DR. MAYNARD DARVY FULLER (NPI# 1679515589) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679515589 |
| Entity Type | Individual |
| Full Name | DR. MAYNARD DARVY FULLER |
| Credential | M.D. |
| Practice Address |
150 S Roadrunner Pkwy Las Cruces NM 88011-7044 |
| Mailing Address |
Po Box 911230 Dallas TX 75391-1230 |
| Practice Telephone | 5055568600 |
| Practice Fax Number | 5055568700 |
| Mailing Telephone | 9729978000 |
| Mailing Fax Number | 9724379605 |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2008-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
G4000 | TX | Allopathic & Osteopathic Physicians |
| Y | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
97239 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 126330301 | 05 | |
| CSHCN | 48753001 | 01 | |
| TX | BLUE CROSS OF TEXAS | 8R1442 | 01 |
| TX | 126330307 | 05 | |
| NM | 000S2815 | 05 | |
| TX | 140998901 | 05 |
| Street Address |
150 S ROADRUNNER PKWY |
| City | LAS CRUCES |
| State | NM |
| Zip Code | 88011-7044 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932148384 | Constance Daphne Wash | Internal Medicine | 150 S Roadrunner Pkwy, Las Cruces, NM 88011-7044 | 2006-06-04 |
| 1699904656 | Texas Oncology, Pa | Radiology | 150 S Roadrunner Pkwy, Las Cruces, NM 88011-7044 | 2009-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356954648 | Asc of The Heart Institute | Internal Medicine | 1250 N Sonoma Ranch Blvd, Las Cruces, NM 88011 | 2020-08-26 |
| 1104449206 | Kruti Gitesh Shah | Student in an Organized Health Care Education/Training Program | Mountain View Regional Medical Cente, Graduate Medical Education, 4351 E Lohman Ave Suite 300, Las Cruces, NM 88011 | 2020-05-22 |
| 1831719368 | Borna Mansouri | Student in an Organized Health Care Education/Training Program | 4351 E. Lahman Ave, Suite 300, Moutnainview Regional Medical Center Graduta, Las Cruces, NM 88011 | 2020-04-24 |
| 1306474408 | Madonna Petula Phillip | Student in an Organized Health Care Education/Training Program | 4351 E Lohmon Avenue Suite 300, Las Cruces, NM 88011 | 2020-04-01 |
| 1285267849 | Back In Action Therapy of Las Cruces | Occupational Therapist | 4440 Sonoma Ranch Blvd, Suite F, Las Cruces, NM 88011 | 2020-02-21 |
| 1649818725 | Kimberly Ann Smetzer | Registered Nurse | 4401 East Lohman, Building 5, Las Cruces, NM 88011 | 2019-12-19 |
| 1548806375 | Melinda Michelle Fowler | Social Worker | 2605 Terrace Drive, Las Cruces, NM 88011 | 2019-11-27 |
| 1871134692 | Rio Grande Hematology and Oncology, LLC | Internal Medicine | 4391 East Lohman Ave., Las Cruces, NM 88011 | 2019-10-02 |
| 1972083640 | Lorianna R. Narvaez | Counselor | 1155 S. Telshor Suite 302-a, Las Cruces, NM 88011 | 2018-08-21 |
| 1215416524 | Aday Orthodontics, PC | Dentist | 2701 Missouri Ave., Suite D, Las Cruces, NM 88011 | 2018-08-08 |
| Find all providers in zip 88011 | ||||
| Taxonomy Code | 207RX0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Medical Oncology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932148384 | Constance Daphne Wash | Internal Medicine | 150 S Roadrunner Pkwy, Las Cruces, NM 88011-7044 | 2006-06-04 |
| 1366439101 | Richard Bush Ross | Internal Medicine | 2477 S Telshor Blvd, Las Cruces, NM 88011-5049 | 2005-10-05 |
| 1477804409 | Las Cruces Cancer Care LLC | Internal Medicine | 1180 Mall Dr, Suite B, Las Cruces, NM 88011-8101 | 2012-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558446187 | San Juan Oncology Associates, PC | Internal Medicine | 735 W Animas St, Farmington, NM 87401-5616 | 2006-10-25 |
| 1013940675 | Bernard M Agbemadzo | Internal Medicine | Pmg Hematology/oncology, 8300 Constitution Ave Ne, Albuquerque, NM 87110 | 2006-07-08 |
| 1225031321 | Jan M Merin | Internal Medicine | 3917 West Rd, Los Alamos, NM 87544-2275 | 2005-05-23 |
| 1720081839 | Clark E Haskins | Internal Medicine | 4901 Lang Avenue Ne, Albuquerque, NM 87109-4397 | 2005-05-23 |
| 1831724517 | Joseph Ekofo | Internal Medicine | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-03-03 |
| 1477882876 | Peter Bernat | Internal Medicine | 2559 Medical Dr, Suite G, Alamogordo, NM 88310-8703 | 2009-12-14 |
| 1609105139 | St. Vincent Hospital | Internal Medicine | 490 A W Zia Rd, Santa Fe, NM 87505-6996 | 2009-12-11 |
| 1750444915 | Esme E Finlay | Internal Medicine | 1201 Camino De Salud Ne, Albuquerque, NM 87102-4517 | 2006-12-19 |
| 1831161082 | Gerald Robertson | Internal Medicine | Rehoboth Mckinley Christian Health Care Services, 2111 College Drive, Gallup, NM 87301 | 2006-02-02 |
| 1275532970 | Ronald P Kubica | Internal Medicine | 4901 Lang Ave Ne, Albuquerque, NM 87109 | 2005-07-15 |
| Find all providers with the same taxonomy | ||||
| City | LAS CRUCES |
| Zip Code | 88011 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.