Provider Demographics
NPI:1588643290
Name:PULS, THEODORE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOSEPH
Last Name:PULS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2644
Mailing Address - Country:US
Mailing Address - Phone:719-561-4336
Mailing Address - Fax:719-561-8469
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-561-4336
Practice Address - Fax:719-561-8469
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23941207Q00000X
CO29341173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01293414Medicaid
CO01293414Medicaid
CON0018Medicare ID - Type Unspecified