MEDICARE: CORKY HUL MEDICAL ASSOC

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	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1962805630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORKY HUL MEDICAL ASSOC

Provider Business Mailing Address
First Line	:	4722 QUAIL LAKES DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-610-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4722 QUAIL LAKES DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-610-1800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CORKY J HULL
Credential	:	M.D.
Telephone Number	:	209-323-9394

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	10/08/2014

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