Provider Demographics
NPI:1407110042
Name:PULIDO INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:PULIDO INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:M
Authorized Official - Last Name:PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-329-9036
Mailing Address - Street 1:700 ZEAGLER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6806
Mailing Address - Country:US
Mailing Address - Phone:386-329-9036
Mailing Address - Fax:386-329-3038
Practice Address - Street 1:700 ZEAGLER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6806
Practice Address - Country:US
Practice Address - Phone:386-329-9036
Practice Address - Fax:386-329-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty