Provider Demographics
NPI:1275538746
Name:HULL, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:HULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:3618 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5403
Practice Address - Country:US
Practice Address - Phone:563-391-4827
Practice Address - Fax:563-386-7349
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA21195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
19878OtherIOWA HEALTH SOLUTIONS
4796890006OtherDMERC
IA3173203Medicaid
IA0138OtherJOHN DEERE HEALTH PLAN
0348000OtherHEALTH ALLIANCE
40004OtherWELLMARK BC/BS
19878OtherIOWA HEALTH SOLUTIONS
IA3173203Medicaid