Individual
DR. BOBBY W TULLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1340 BROAD AVE STE 410, GULFPORT, MS 39501-2459
(228) 575-1775
(228) 575-1770
Mailing address
860 S MADISON ST, TUPELO, MS 38801-4905
(662) 377-7150
(662) 377-7155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23030
MS
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
23030
MS
207RP1001X
Pulmonary Disease Physician
Primary
23030
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23030
STATE MEDICAL LICENSE
MS
Enumeration date
06/29/2012
Last updated
08/10/2023
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