Provider Demographics
NPI:1972599355
Name:PULAS, GREGORY T (DPM)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:T
Last Name:PULAS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:3031 W MARCH LN
Mailing Address - Street 2:203W
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6500
Mailing Address - Country:US
Mailing Address - Phone:209-956-2847
Mailing Address - Fax:209-956-3514
Practice Address - Street 1:3031 W MARCH LN
Practice Address - Street 2:203
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6500
Practice Address - Country:US
Practice Address - Phone:209-956-2847
Practice Address - Fax:209-956-3514
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2008-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE2807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28070Medicaid
CA000E28071Medicaid
000E28070Medicare ID - Type Unspecified
CA000E28070Medicaid