Provider Demographics
NPI:1639130628
Name:HULL, GERALD W III (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:W
Last Name:HULL
Suffix:III
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 1:391 SERPENTINE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3083
Mailing Address - Country:US
Mailing Address - Phone:864-585-8221
Mailing Address - Fax:864-216-4290
Practice Address - Street 1:391 SERPENTINE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3083
Practice Address - Country:US
Practice Address - Phone:864-585-8221
Practice Address - Fax:864-216-4290
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16661208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC166616Medicaid
SCG93346Medicare UPIN
SC166616Medicaid
SCG993464300Medicare ID - Type Unspecified