Provider Demographics
NPI:1366422073
Name:TULLIS, GENE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:EDWARD
Last Name:TULLIS
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 1:1801 16TH ST
Mailing Address - Street 2:NCMC PULM CLINIC BANNER HEALTH
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4500
Mailing Address - Country:US
Mailing Address - Phone:970-810-2026
Mailing Address - Fax:970-810-2028
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-810-2026
Practice Address - Fax:970-810-2028
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23142208G00000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01231422Medicaid
COP00134623OtherRAILROAD MEDICARE
CO01231422Medicaid
COCO306439Medicare PIN
COC533518Medicare PIN