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General NPI Number Information
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NPI Number | 1871883066
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Entity Type | Individual
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Provider Name | LAURA JILL TULLY MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2011
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 31 S STANFIELD RD STE 304
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City | TROY
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State | OH
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Zip | 45373-2334
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Country | US
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Telephone | 937-440-7872
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Fax | 937-440-7874
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Provider Business Mailing Address
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Address Line | 3170 KETTERING BLVD BUILDING B, 3RD FLOOR
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City | MORAINE
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State | OH
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Zip | 45439-1924
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Country | US
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Telephone | 937-991-3188
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Fax | 937-223-9811
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | Q7611
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | CDR.0005758
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35.132034
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | C3349
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License Number State | KY
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