Provider Demographics
NPI:1063401495
Name:PULLIAS, GARY MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MITCHELL
Last Name:PULLIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 MANATEE AVE. WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205
Mailing Address - Country:US
Mailing Address - Phone:941-748-8855
Mailing Address - Fax:941-748-8465
Practice Address - Street 1:2704 MANATEE AVE. WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-748-8855
Practice Address - Fax:941-748-8465
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067686100Medicaid
FL41190Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
FL067686100Medicaid