Basic Information
| Provider Information | |||||||||
| NPI: | 1437118098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PULLARA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 433 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983626219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604523373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 433 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983626219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604523373 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 02/20/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00043007 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8384653 | 05 | WA | MEDICAID | 501872 | 01 | WI | UNITED GOVERNMENT SERVICE | OTHER |