Provider Demographics
NPI:1679575500
Name:PULLEN, PHILLIP A (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:PULLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8370 W HILLSBOROUGH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3898
Mailing Address - Country:US
Mailing Address - Phone:813-302-1733
Mailing Address - Fax:813-881-1801
Practice Address - Street 1:8370 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3898
Practice Address - Country:US
Practice Address - Phone:813-302-1733
Practice Address - Fax:813-881-1801
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9141207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37616OtherBLUE SHIELD FLORIDA
FL6007198002OtherCIGNA
FL7931531OtherAETNA
FL270122OtherWELLCARE/STAYWELL
FL7931531OtherAETNA
FL6007198002OtherCIGNA
FL386960001Medicare NSC