Provider Demographics
NPI:1548215916
Name:PULIDO, QUINTIN M (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:QUINTIN
Middle Name:M
Last Name:PULIDO
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2418 N OAK ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2534
Mailing Address - Country:US
Mailing Address - Phone:229-247-7220
Mailing Address - Fax:229-247-0161
Practice Address - Street 1:2418 N OAK ST
Practice Address - Street 2:SUITE F
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2534
Practice Address - Country:US
Practice Address - Phone:229-247-7220
Practice Address - Fax:229-247-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA019090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA46899OtherFIRST COAST MEDICARE
GA023052OtherBLUE CROSS BLUE SHIELD GA
GA037774100OtherFLORIDA MEDICAID
GAP00076370OtherMEDICARE RAILROAD
GA000138487AMedicaid
GA023052OtherBLUE CROSS BLUE SHIELD GA