Healthcare Provider Details

I. General information

NPI: 1407933666
Provider Name (Legal Business Name): DAVID J. STRULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL PKWY
CARSON CITY NV
89703-4625
US

IV. Provider business mailing address

1600 MEDICAL PKWY
CARSON CITY NV
89703-4625
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-8005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5231
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5231
License Number StateNV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNV4709
Identifier TypeOTHER
Identifier StateNV
Identifier IssuerBCBS
# 2
Identifier201317504
Identifier TypeMEDICAID
Identifier StateNV
Identifier Issuer
# 3
IdentifierB012
Identifier TypeOTHER
Identifier StateNV
Identifier IssuerTRICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: