Provider Demographics
NPI:1225073976
Name:TULL, DUANE F (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:F
Last Name:TULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DUANE
Other - Middle Name:
Other - Last Name:TULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:104 E CENTRAL AVE
Mailing Address - Street 2:P.O. BOX 430
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721-8902
Mailing Address - Country:US
Mailing Address - Phone:570-753-8620
Mailing Address - Fax:570-753-5489
Practice Address - Street 1:1020 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1729
Practice Address - Country:US
Practice Address - Phone:570-753-8077
Practice Address - Fax:570-753-8453
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108524208600000X
DEC1-0006243208600000X
MDD0054656208600000X
PAMD43322208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96377Medicare UPIN