Provider Demographics
NPI:1083177141
Name:TULLIS, JAMES PARKS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PARKS
Last Name:TULLIS
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 1:1002 S 52ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8610
Mailing Address - Country:US
Mailing Address - Phone:479-338-3750
Mailing Address - Fax:479-338-3799
Practice Address - Street 1:1002 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8610
Practice Address - Country:US
Practice Address - Phone:479-338-3750
Practice Address - Fax:479-338-3799
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-14862207R00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program