Healthcare Provider Details

I. General information

NPI: 1124080460
Provider Name (Legal Business Name): JAMES RICHARD TULLOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 W MARION RD
MOUNT GILEAD OH
43338-1027
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 567-876-6370
  • Fax: 614-533-1444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-062215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: