Healthcare Provider Details

I. General information

NPI: 1457357691
Provider Name (Legal Business Name): TULIO FIGAROLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HIGHWAY 61 N
VICKSBURG MS
39183-8211
US

IV. Provider business mailing address

2100 HIGHWAY 61 N
VICKSBURG MS
39183-8211
US

V. Phone/Fax

Practice location:
  • Phone: 601-883-3391
  • Fax: 901-883-3395
Mailing address:
  • Phone: 601-883-5000
  • Fax: 601-883-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number23597
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number22925
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: