MEDICARE: JOHN F CULLEN MD

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	207Q00000X	Family Medicine Physician	MD0025362	FL

General Provider Information

NPI Number	:	1225216120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN F CULLEN MD

Provider Business Mailing Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	STE D2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-676-2302
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	STE D2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-676-2302
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MGR.
Name	:	JUDY C DRISCOLL
Credential	:
Telephone Number	:	386-676-2302

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/04/2008

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