Healthcare Provider Details

I. General information

NPI: 1851360887
Provider Name (Legal Business Name): MICHAEL THOMAS PULLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W 8TH ST UFJP NEUROLOGY
JACKSONVILLE FL
32209-6533
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-3960
  • Fax: 904-244-3425
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME80022
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME80022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: