Individual
DR. THOMAS W TULLY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 N BONITA AVE, PANAMA CITY, FL 32401-3623
(850) 747-6000
Mailing address
615 N BONITA AVE, PANAMA CITY, FL 32401-3623
(850) 747-6000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
102657
FL
207P00000X
Emergency Medicine Physician
42410-20
WI
207P00000X
Emergency Medicine Physician
MD00033876
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8195596
—
WA
01
—
930103921
RAILROAD MEDICARE
—
01
—
M18541
REGENCE BLUE SHIELD RIDER
—
Enumeration date
03/08/2006
Last updated
03/26/2015
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