Provider Demographics
NPI:1487187928
Name:PULLUM, BRIAN DAVID
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:PULLUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E CLARK BASS BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4269
Mailing Address - Country:US
Mailing Address - Phone:918-421-8897
Mailing Address - Fax:918-302-0825
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4269
Practice Address - Country:US
Practice Address - Phone:918-421-8897
Practice Address - Fax:918-302-0825
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic