Provider Demographics
NPI:1023004397
Name:STULTS, RICHARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:STULTS
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 1:1265 E COLLEGE ST
Mailing Address - Street 2:RICHARD F. STULTS, MD
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478
Mailing Address - Country:US
Mailing Address - Phone:931-381-8492
Mailing Address - Fax:931-388-7119
Practice Address - Street 1:1265 E COLLEGE ST
Practice Address - Street 2:RICHARD F. STULTS, MD
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478
Practice Address - Country:US
Practice Address - Phone:931-381-8492
Practice Address - Fax:931-388-7119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD213112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4015072OtherBLUE CROSS PROVIDER NUMBE
TN3063375Medicaid
TN4015072OtherBLUE CROSS PROVIDER NUMBE
TN3063375Medicare ID - Type Unspecified