Provider Demographics
NPI:1710923388
Name:PULLIAM, JOHN H JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:PULLIAM
Suffix:JR
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 1:200 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5056
Mailing Address - Country:US
Mailing Address - Phone:903-957-3230
Mailing Address - Fax:903-957-4046
Practice Address - Street 1:200 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5056
Practice Address - Country:US
Practice Address - Phone:903-957-3230
Practice Address - Fax:903-957-4046
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0737207T00000X
ARE-6727207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3284675OtherBCBS
TX140002115OtherRR MEDICARE
TX0451684-01Medicaid
TX140002115OtherRR MEDICARE
TX86K941Medicare ID - Type UnspecifiedMEDICARE