Provider Demographics
NPI:1104811744
Name:LULLOVE, ERIC JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAY
Last Name:LULLOVE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 W HILLSBORO BLVD
Mailing Address - Street 2:STE B6
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4356
Mailing Address - Country:US
Mailing Address - Phone:561-989-9780
Mailing Address - Fax:561-989-9781
Practice Address - Street 1:4855 W HILLSBORO BLVD
Practice Address - Street 2:STE B6
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4356
Practice Address - Country:US
Practice Address - Phone:561-989-9780
Practice Address - Fax:561-989-9781
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3133213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340480300Medicaid
FLU2536Medicare PIN
FL340480300Medicaid