Individual
DR. MICAM W. TULLOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 N SAN SABA, SUITE 1210, SAN ANTONIO, TX 78207-3154
(210) 354-0877
(210) 354-0880
Mailing address
315 N SAN SABA, SUITE 1210, SAN ANTONIO, TX 78207-3154
(210) 354-0877
(210) 354-0880
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
G8470
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124306501
—
TX
05
—
12430695-06
—
TX
01
—
3339002
BC/BS
TX
Enumeration date
07/09/2006
Last updated
06/28/2013
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