Basic Information
| Provider Information | |||||||||
| NPI: | 1649553850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TULLMAN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1021 | ||||||||
| Address2: | HWY 83 & OAKHILL DR. | ||||||||
| City: | LEAKEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788731021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302326985 | ||||||||
| FaxNumber: | 8302326961 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 S. EVANS | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788015141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302785604 | ||||||||
| FaxNumber: | 8302781836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2011 | ||||||||
| LastUpdateDate: | 09/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA09041 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.