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General NPI Number Information
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NPI Number | 1780728246
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Entity Type | Organization
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Legal Business Name | DAVID M TULLY SMITH M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 711 D ST SUITE 111
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3707
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Country | US
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Telephone | 415-453-3030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3137
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City | ROHNERT PARK
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State | CA
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Zip | 94927-3137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. DANA TULLY-SMITH
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Credential |
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Telephone | 707-544-2632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G30229
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License Number State | CA
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