Provider Demographics
NPI:1033357553
Name:PULIDO, RENE URIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:URIEL
Last Name:PULIDO
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 1:2570 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3604
Mailing Address - Country:US
Mailing Address - Phone:904-647-8576
Mailing Address - Fax:904-253-3098
Practice Address - Street 1:2570 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3604
Practice Address - Country:US
Practice Address - Phone:904-647-8576
Practice Address - Fax:904-253-3098
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
FLME103456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004248300OtherMEDIPASS
FL338970OtherAVMED
FL000934500Medicaid
FL148KPOtherBLUE CROSS BLUE SHIELD
FL6683250001OtherNSC DMEPOS
FL9818064OtherCIGNA
FL004248300Medicaid