Provider Demographics
NPI:1700983830
Name:TULLIS, NORMAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:E
Last Name:TULLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:#540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5209
Mailing Address - Country:US
Mailing Address - Phone:417-847-3500
Mailing Address - Fax:417-847-3523
Practice Address - Street 1:75 SMITHSON DR
Practice Address - Street 2:SUITE A
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-9429
Practice Address - Country:US
Practice Address - Phone:417-847-3500
Practice Address - Fax:417-847-3523
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-11-20
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Provider Licenses
StateLicense IDTaxonomies
MO102984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203729108Medicaid
4068OtherBLUE CROSS OF MO
P00116934Medicare PIN
4068OtherBLUE CROSS OF MO
916534158Medicare PIN