Provider Demographics
NPI:1548354574
Name:PULITO, JOSEPH FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANCIS
Last Name:PULITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 555
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-288-7535
Practice Address - Fax:503-288-7538
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10705208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202660Medicaid
WA1548354574Medicaid
OOWCBDBDMedicare ID - Type Unspecified
WA1548354574Medicaid
E79061Medicare UPIN
OR164864Medicare PIN