Individual
DR. BRYAN P TULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5666 EAST STATE STREET, ROCKFORD, IL 61108-2425
(815) 226-2000
Mailing address
5666 EAST STATE STREET, ROCKFORD, IL 61108-2425
(815) 226-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-126036
IL
207R00000X
Internal Medicine Physician
MT191660
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036126036
—
IL
Enumeration date
03/03/2010
Last updated
02/10/2011
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