MEDICARE: DR. CHRISTOPHER LAWRENCE PULLIAM D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	POD305061	GA
2	213E00000X	Podiatrist	12-00359	KS
3	213ES0000X	Sports Medicine Podiatrist	0359	KS
4	213ES0131X	Foot Surgery Podiatrist	12-00359	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO4499	OTHER	FL	PODIATRY
2	12-00359	OTHER	KS	KANSAS LICENSE NUMBER

General Provider Information

NPI Number	:	1134183270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER LAWRENCE PULLIAM D.P.M.

Provider Business Mailing Address
First Line	:	3497 LAWTON PL
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-8262
Country	:	US
Telephone Number	:	913-708-4802
Fax Number	:

Provider Business Practice Location Address
First Line	:	3497 LAWTON PL
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-8262
Country	:	US
Telephone Number	:	913-708-4802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	12/02/2025

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