Healthcare Provider Details

I. General information

NPI: 1811287816
Provider Name (Legal Business Name): JOSEPH CARDWELL FULLER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 09/29/2026
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 E GEDDES AVE STE 200
ENGLEWOOD CO
80112-3861
US

IV. Provider business mailing address

10700 E GEDDES AVE STE 200
ENGLEWOOD CO
80112-3861
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-9190
  • Fax: 720-874-4462
Mailing address:
  • Phone: 303-761-9190
  • Fax: 720-874-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number29941
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2016-01080
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-39828
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number58155
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: