Provider Demographics
NPI:1447447081
Name:TULL, STEVEN ANDREW (PA C)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANDREW
Last Name:TULL
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:633 GOV CARLOS CAMACHO RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-7232
Mailing Address - Fax:671-649-7233
Practice Address - Street 1:633 GOV CARLOS CAMACHO RD
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-7232
Practice Address - Fax:671-649-7233
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12759363AM0700X
GUPA20363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU103152Medicare UPIN