MEDICARE: DR. DOUGLAS B PULLEY M.D.

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	207W00000X	Ophthalmology Physician	A24242	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952341125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS B PULLEY M.D.

Provider Business Mailing Address
First Line	:	10300 S DE ANZA BLVD
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-3030
Country	:	US
Telephone Number	:	408-252-7100
Fax Number	:	408-257-8355

Provider Business Practice Location Address
First Line	:	393 BLOSSOM HILL RD
Second Line	:	SUITE 265
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1652
Country	:	US
Telephone Number	:	408-227-7122
Fax Number	:	408-227-7722

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/23/2011

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