MEDICARE: DR. RICHARD F STULTS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD21311	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4015072	OTHER	TN	BLUE CROSS PROVIDER NUMBE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023004397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD F STULTS MD

Provider Business Mailing Address
First Line	:	1265 E COLLEGE ST
Second Line	:	RICHARD F. STULTS, MD
City	:	PULASKI
State	:	TN
Zip	:	38478
Country	:	US
Telephone Number	:	931-381-8492
Fax Number	:	931-388-7119

Provider Business Practice Location Address
First Line	:	1265 E COLLEGE ST
Second Line	:	RICHARD F. STULTS, MD
City	:	PULASKI
State	:	TN
Zip	:	38478
Country	:	US
Telephone Number	:	931-381-8492
Fax Number	:	931-388-7119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/08/2007

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