Organization
DAVID A VERTULLO MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID ANTHONY VERTULLO M.D. (OWNER)
(480) 596-8525
Entity
Organization
Contact information
Practice address
1930 E THOMAS RD, PHOENIX, AZ 85016-7711
(480) 596-8525
(480) 596-8522
Mailing address
PO BOX 26904, PHOENIX, AZ 85068-6904
(480) 596-8525
(480) 596-8522
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
34938
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0440730
BLUE CROSS BLUE SHIELD
AZ
05
—
109820
—
AZ
01
—
PENDING
RAILROAD MEDICARE
—
01
—
ZA5362
HEALTHNET
AZ
Enumeration date
06/22/2006
Last updated
10/05/2007
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