Provider Demographics
NPI:1740399658
Name:TULL, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:TULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:ANTHONY
Other - Last Name:TULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12100 SE STEVENS CT
Mailing Address - Street 2:STE 106
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4707
Mailing Address - Country:US
Mailing Address - Phone:503-331-6330
Mailing Address - Fax:503-353-7338
Practice Address - Street 1:12100 SE STEVENS CT
Practice Address - Street 2:STE 106
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-4707
Practice Address - Country:US
Practice Address - Phone:503-331-6330
Practice Address - Fax:503-353-7338
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18579207W00000X
WAMD00034868207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A50184Medicare UPIN