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General NPI Number Information
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NPI Number | 1306807003
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Entity Type | Individual
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Provider Name | THOMAS RAY CULLISON MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-7424
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Fax | 757-953-5166
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Provider Business Mailing Address
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Address Line | 580 WILLIAMSON DR
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City | PORTSMOUTH
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State | VA
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Zip | 23704-7200
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Country | US
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Telephone | 757-953-7424
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Fax | 757-953-5166
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01029434A
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License Number State | IN
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