Individual
MR. JACOB JOSEPH TULLIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7573 N EDGEWATER AVE, PORTLAND, OR 97203-5081
(915) 319-0828
Mailing address
7573 N EDGEWATER AVE, PORTLAND, OR 97203-5081
(915) 319-0828
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
10008790
OR
Other
Enumeration date
02/28/2026
Last updated
02/28/2026
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