Provider Demographics
NPI:1881781185
Name:CULLEN, JOHN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:CULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1829
Mailing Address - Street 2:
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686-1829
Mailing Address - Country:US
Mailing Address - Phone:907-835-4811
Mailing Address - Fax:907-835-5162
Practice Address - Street 1:1001 MEALS AVE.
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686
Practice Address - Country:US
Practice Address - Phone:907-835-4811
Practice Address - Fax:907-835-5162
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD14902Medicaid
AKMD14902Medicaid
AKF74746Medicare UPIN