Healthcare Provider Details

I. General information

NPI: 1386619096
Provider Name (Legal Business Name): JOHN F HULL D.O,P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 N SUMMIT ST
CRESCENT CITY FL
32112-1724
US

IV. Provider business mailing address

5 HUNTSMAN LOOK
ORMOND BEACH FL
32174-2433
US

V. Phone/Fax

Practice location:
  • Phone: 386-698-2101
  • Fax: 386-698-2364
Mailing address:
  • Phone: 386-698-2101
  • Fax: 386-698-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 4047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: