Healthcare Provider Details

I. General information

NPI: 1578545414
Provider Name (Legal Business Name): THOMAS R HULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 N DIVISION ST
SPOKANE WA
99208-1026
US

IV. Provider business mailing address

5904 N DIVISION ST
SPOKANE WA
99208-1026
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-1150
  • Fax: 509-482-6010
Mailing address:
  • Phone: 509-489-1150
  • Fax: 509-482-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00024414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: