Healthcare Provider Details

I. General information

NPI: 1871883066
Provider Name (Legal Business Name): LAURA JILL TULLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA JILL WHITE

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 S STANFIELD RD STE 304
TROY OH
45373-2334
US

IV. Provider business mailing address

3170 KETTERING BLVD BUILDING B, 3RD FLOOR
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-440-7872
  • Fax: 937-440-7874
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberQ7611
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberCDR.0005758
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.132034
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC3349
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: