MEDICARE: DR. DAVID D DULL 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	213EP1101X	Primary Podiatric Medicine Podiatrist	36-001383	OH
2	213ER0200X	Radiology Podiatrist	36-001383	OH
3	213ES0000X	Sports Medicine Podiatrist	36-001383	OH
4	213ES0103X	Foot & Ankle Surgery Podiatrist	36-001383	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942206875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID D DULL D.P.M.

Provider Business Mailing Address
First Line	:	4442 LOGAN WAY
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1739
Country	:	US
Telephone Number	:	330-759-0904
Fax Number	:	330-759-2201

Provider Business Practice Location Address
First Line	:	4442 LOGAN WAY
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1739
Country	:	US
Telephone Number	:	330-759-0904
Fax Number	:	330-759-2201

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/20/2008

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