MEDICARE: DR. MARK TULLOS 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	208600000X	Surgery Physician	M3773	TX

General Provider Information

NPI Number	:	1952365207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK TULLOS M.D.

Provider Business Mailing Address
First Line	:	605 E SAN ANTONIO ST STE 510E
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-6011
Country	:	US
Telephone Number	:	361-576-9342
Fax Number	:	361-576-9353

Provider Business Practice Location Address
First Line	:	605 E SAN ANTONIO ST STE 510E
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-6011
Country	:	US
Telephone Number	:	361-576-9342
Fax Number	:

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	12/15/2020

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