Healthcare Provider Details

I. General information

NPI: 1952361891
Provider Name (Legal Business Name): ERIC J LULLOVE DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 W HILLSBORO BLVD STE B6
COCONUT CREEK FL
33073-4356
US

IV. Provider business mailing address

4855 W HILLSBORO BLVD STE B6
COCONUT CREEK FL
33073-4356
US

V. Phone/Fax

Practice location:
  • Phone: 561-989-9780
  • Fax: 561-989-9781
Mailing address:
  • Phone: 561-989-9780
  • Fax: 561-989-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3133
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO3133
License Number StateFL

VIII. Authorized Official

Name: DR. ERIC JAY LULLOVE
Title or Position: OWNER/PRESIDENT
Credential: D.P.M.
Phone: 561-989-9780