Healthcare Provider Details

I. General information

NPI: 1508949538
Provider Name (Legal Business Name): JOSEPH DANIEL HULL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15444 DEDEAUX RD STE B
GULFPORT MS
39503-2637
US

IV. Provider business mailing address

15444 DEDEAUX RD STE B
GULFPORT MS
39503-2637
US

V. Phone/Fax

Practice location:
  • Phone: 228-832-9038
  • Fax:
Mailing address:
  • Phone: 228-832-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08920
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number08920
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number08920
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: