Healthcare Provider Details

I. General information

NPI: 1225035751
Provider Name (Legal Business Name): RALPH JAMES TULLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 CHERRY RIDGE DR
LAKE MARY FL
32746-1945
US

IV. Provider business mailing address

1640 CHERRY RIDGE DR
LAKE MARY FL
32746-1945
US

V. Phone/Fax

Practice location:
  • Phone: 321-262-9670
  • Fax:
Mailing address:
  • Phone: 321-262-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME45972
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME45972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: