Provider Demographics
NPI:1457392144
Name:CULL, ANTHONY SALVATORE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:SALVATORE
Last Name:CULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2726 SE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1309
Mailing Address - Country:US
Mailing Address - Phone:503-807-5110
Mailing Address - Fax:888-826-4380
Practice Address - Street 1:3810 SE DIVISION ST STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1641
Practice Address - Country:US
Practice Address - Phone:503-208-2262
Practice Address - Fax:888-826-4380
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD251432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry