Healthcare Provider Details

I. General information

NPI: 1962805630
Provider Name (Legal Business Name): CORKY HUL MEDICAL ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 QUAIL LAKES DR
STOCKTON CA
95207-5256
US

IV. Provider business mailing address

4722 QUAIL LAKES DR
STOCKTON CA
95207-5256
US

V. Phone/Fax

Practice location:
  • Phone: 209-610-1800
  • Fax:
Mailing address:
  • Phone: 209-610-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CORKY J HULL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-323-9394