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General NPI Number Information
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NPI Number | 1285053421
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Entity Type | Individual
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Provider Name | JOSE ETHAN PULIDO MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 2 INDUSTRIAL BLVD BLDG C STE 120
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 610-647-3660
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Fax | 610-644-2165
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Provider Business Mailing Address
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Address Line | 211 S GULPH RD STE 200
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3101
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Country | US
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Telephone | 610-382-5916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MT205718
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD466849
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License Number State | PA
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