Individual
MR. MICHAEL B STULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
904 S DALLAS AVE APT 3, PORTALES, NM 88130-6028
(575) 784-0287
Mailing address
904 S DALLAS AVE APT 3, PORTALES, NM 88130-6028
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
12/09/2009
Last updated
08/19/2010
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