Healthcare Provider Details

I. General information

NPI: 1811930779
Provider Name (Legal Business Name): ROBERT ALLEN HULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 TAMIAMI TRL STE 4
PORT CHARLOTTE FL
33952-5100
US

IV. Provider business mailing address

2852 TAMIAMI TRL STE 4
PORT CHARLOTTE FL
33952-5100
US

V. Phone/Fax

Practice location:
  • Phone: 941-286-2432
  • Fax:
Mailing address:
  • Phone: 941-286-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME88340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: