Provider Demographics
NPI:1225216120
Name:JOHN F CULLEN MD
Entity Type:Organization
Organization Name:JOHN F CULLEN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-676-2302
Mailing Address - Street 1:290 CLYDE MORRIS BLVD
Mailing Address - Street 2:STE D2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8130
Mailing Address - Country:US
Mailing Address - Phone:386-676-2302
Mailing Address - Fax:
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:STE D2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8130
Practice Address - Country:US
Practice Address - Phone:386-676-2302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD0025362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58424Medicare UPIN
FLK0856Medicare PIN