Provider Demographics
NPI:1639291354
Name:ARCHER K TULLIDGE
Entity Type:Organization
Organization Name:ARCHER K TULLIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:TULLIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-290-8730
Mailing Address - Street 1:402 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4622
Mailing Address - Country:US
Mailing Address - Phone:281-290-8730
Mailing Address - Fax:281-255-8473
Practice Address - Street 1:402 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4622
Practice Address - Country:US
Practice Address - Phone:281-290-8730
Practice Address - Fax:281-255-8473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK19442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00116VMedicare PIN