Provider Demographics
NPI:1265502355
Name:ULLO, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:ULLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29750 US HIGHWAY 19 N STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1510
Mailing Address - Country:US
Mailing Address - Phone:727-786-5058
Mailing Address - Fax:813-635-2639
Practice Address - Street 1:29750 US HIGHWAY 19 N STE 101
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1510
Practice Address - Country:US
Practice Address - Phone:727-786-5058
Practice Address - Fax:813-635-2639
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00611843OtherRAILROAD MEDICARE PROVIDER NUMBER
FL279301600Medicaid
FL279301600Medicaid
FLAE667XMedicare PIN