Provider Demographics
NPI:1386619096
Name:HULL, JOHN F (DO,PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:HULL
Suffix:
Gender:M
Credentials:DO,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HUNTSMAN LOOK
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2433
Mailing Address - Country:US
Mailing Address - Phone:386-698-2101
Mailing Address - Fax:386-698-2364
Practice Address - Street 1:921 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-1724
Practice Address - Country:US
Practice Address - Phone:386-698-2101
Practice Address - Fax:386-698-2364
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 4047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82271OtherBCBS OF FL PROVIDER
FL82271OtherBCBS OF FL PROVIDER
FLK0472Medicare ID - Type UnspecifiedFLORIDA MEDICARE PROVIDER