Provider Demographics
NPI:1194721019
Name:PULSIPHER, DAN W (DO)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:W
Last Name:PULSIPHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:5089 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1326
Practice Address - Country:US
Practice Address - Phone:727-375-7929
Practice Address - Fax:813-635-2634
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044062207Q00000X
FLOS9454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03540OtherBCBS
FL272237200Medicaid
GA000756819JMedicaid
GA000756819JMedicaid
FL03540ZMedicare PIN