Provider Demographics
NPI:1730482167
Name:PULLINS, MICAH DAVID (DO)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:DAVID
Last Name:PULLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5880 S HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9447
Mailing Address - Country:US
Mailing Address - Phone:928-402-1131
Mailing Address - Fax:928-425-7903
Practice Address - Street 1:5880 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9447
Practice Address - Country:US
Practice Address - Phone:928-425-3246
Practice Address - Fax:928-425-3859
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017901207X00000X
NVDO2109207X00000X
WY9494A207X00000X
AZ011855207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1730482167Medicaid
WYW25532OtherMEDICARE