Provider Demographics
NPI:1275513541
Name:RULLAN, ALBERTO ANTONIO (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:ANTONIO
Last Name:RULLAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 ST VINCENTS WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8431
Mailing Address - Country:US
Mailing Address - Phone:904-291-4885
Mailing Address - Fax:
Practice Address - Street 1:1740 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208
Practice Address - Country:US
Practice Address - Phone:904-224-2001
Practice Address - Fax:904-224-2002
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004908-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1400062OtherGHI
NYPO-4908-1OtherWORKMAN'S COMP
NY01497938Medicaid
NYP52221OtherBLUE CROSS/BLUE SHIELD
NY1400062OtherGHI
NYPO-4908-1OtherWORKMAN'S COMP