Provider Demographics
NPI:1588968721
Name:GARY M PULLIAS M.D. PA
Entity type:Organization
Organization Name:GARY M PULLIAS M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-748-8855
Mailing Address - Street 1:2704 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4940
Mailing Address - Country:US
Mailing Address - Phone:941-748-8855
Mailing Address - Fax:941-748-8465
Practice Address - Street 1:2704 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4940
Practice Address - Country:US
Practice Address - Phone:941-748-8855
Practice Address - Fax:941-748-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37875261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41190Medicare PIN