Provider Demographics
NPI:1730507096
Name:CULLINANE, WILLIAM RUSSELL JR (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:CULLINANE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15190 COMMUNITY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3484
Mailing Address - Country:US
Mailing Address - Phone:228-539-3356
Mailing Address - Fax:
Practice Address - Street 1:15190 COMMUNITY RD STE 110
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3484
Practice Address - Country:US
Practice Address - Phone:228-539-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO4083207RC0200X, 207RP1001X
MS27720207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine