Basic Information
| Provider Information | |||||||||
| NPI: | 1952309114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PULLIN | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | LOUIS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 680819 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782680819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106809393 | ||||||||
| FaxNumber: | 2106817906 | ||||||||
| Practice Location | |||||||||
| Address1: | 7913 BANDERA RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782506511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106809393 | ||||||||
| FaxNumber: | 2106817906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 02/16/2009 | ||||||||
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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 | J8726 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | J8726 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080187389 | 01 | MEDICARE RAILROAD | OTHER | 0076EG | 01 | TX | BCBS | OTHER | 0088MC | 01 | TX | BCBS GROUP ID | OTHER | J8726 | 01 | TX | STATE LICENSE | OTHER |