Provider Demographics
NPI:1912195314
Name:PULLEN, DAVID JOHN (CSA, CTBS, BS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:PULLEN
Suffix:
Gender:M
Credentials:CSA, CTBS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:5557 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3344
Mailing Address - Country:US
Mailing Address - Phone:757-497-3310
Mailing Address - Fax:
Practice Address - Street 1:5557 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3344
Practice Address - Country:US
Practice Address - Phone:757-497-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical