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Individual

MR. CHARLES A TULLEY III

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1101 S EUSTIS ST, EUSTIS, FL 32726-5558
(352) 589-4111
(352) 589-4245
Mailing address
1101 S EUSTIS ST, EUSTIS, FL 32726-5558
(352) 589-4111
(352) 589-4245

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME36920
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
35187
BCBS
FL
Enumeration date
06/13/2006
Last updated
07/08/2007
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