Provider Demographics
NPI:1134183270
Name:PULLIAM, CHRISTOPHER LAWRENCE (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LAWRENCE
Last Name:PULLIAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3497 LAWTON PL
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8262
Mailing Address - Country:US
Mailing Address - Phone:913-708-4802
Mailing Address - Fax:
Practice Address - Street 1:3497 LAWTON PL
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-8262
Practice Address - Country:US
Practice Address - Phone:913-708-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00359213E00000X, 213ES0131X
KS0359213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO4499OtherPODIATRY
KS12-00359OtherKANSAS LICENSE NUMBER