1184604332 NPI number — JEFFREY F HULL II DO

Table of content: JEFFREY F HULL II DO (NPI 1184604332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184604332 NPI number — JEFFREY F HULL II DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULL
Provider First Name:
JEFFREY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184604332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5281 N 99TH AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85305-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-516-8252
Provider Business Mailing Address Fax Number:
623-516-8253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19636 N 27TH AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85022-4014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-516-8252
Provider Business Practice Location Address Fax Number:
623-516-8253
Provider Enumeration Date:
01/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  R9D77 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 3981 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150527 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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