MEDICARE: DAVID D. DULL DPM LLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36001383	OH

General Provider Information

NPI Number	:	1497008361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID D. DULL DPM LLC

Provider Business Mailing Address
First Line	:	4442 LOGAN WAY
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4442 LOGAN WAY
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1739
Country	:	US
Telephone Number	:	330-759-0904
Fax Number	:	330-759-2201

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. DAVID D DULL
Credential	:	DPM
Telephone Number	:	330-759-0904

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	10/17/2012

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