Individual
DR. MARK J TULLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3009 N BALLAS RD, SUITE 207B, SAINT LOUIS, MO 63131-2322
(314) 996-7960
(314) 989-0235
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(314) 996-7960
(314) 989-0235
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2011013368
MO
2084N0400X
Neurology Physician
215887-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02236895
—
NY
Enumeration date
07/28/2006
Last updated
03/22/2021
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