Provider Demographics
NPI:1154491504
Name:TULANON, PAITOON (MD)
Entity Type:Individual
Prefix:DR
First Name:PAITOON
Middle Name:
Last Name:TULANON
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 1:3409 WORTH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2029
Mailing Address - Country:US
Mailing Address - Phone:214-824-1730
Mailing Address - Fax:214-821-7756
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-824-1730
Practice Address - Fax:214-821-7756
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7731208C00000X
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1229049-03Medicaid
TX1229049-03Medicaid
TX394619YKY6Medicare PIN