Basic Information
| Provider Information | |||||||||
| NPI: | 1275538746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULL | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 865 LINCOLN RD | ||||||||
| Address2: | STE L10 | ||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527224159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633559191 | ||||||||
| FaxNumber: | 5633553419 | ||||||||
| Practice Location | |||||||||
| Address1: | 3618 N DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528065403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633914827 | ||||||||
| FaxNumber: | 5633867349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21195 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 19878 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 4796890006 | 01 | DMERC | OTHER | 3173203 | 05 | IA | MEDICAID | IA0138 | 01 | JOHN DEERE HEALTH PLAN | OTHER | 0348000 | 01 | HEALTH ALLIANCE | OTHER | 40004 | 01 | WELLMARK BC/BS | OTHER |