Provider Demographics
NPI:1134160120
Name:PULLIAM, ANDREW RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:PULLIAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7405
Mailing Address - Country:US
Mailing Address - Phone:907-745-9200
Mailing Address - Fax:907-745-9201
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 201
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-745-9200
Practice Address - Fax:907-745-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4516207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1013105Medicaid
K160457OtherPTAN