Healthcare Provider Details

I. General information

NPI: 1710923388
Provider Name (Legal Business Name): JOHN H PULLIAM JR. M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E EVERGREEN ST
SHERMAN TX
75090-5056
US

IV. Provider business mailing address

200 E EVERGREEN ST
SHERMAN TX
75090-5056
US

V. Phone/Fax

Practice location:
  • Phone: 903-957-3230
  • Fax: 903-957-4046
Mailing address:
  • Phone: 903-957-3230
  • Fax: 903-957-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberH0737
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberE-6727
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: