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Individual
DAVID SHIRLEY BULLOCK
Active
Individual
DAVID SHIRLEY BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
39587
KY
207Q00000X
Family Medicine Physician
Primary
39587
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000495658
ANTHEM BC BS
—
01
—
11606348
CAQH
—
01
—
1230533
CHA
—
01
—
611064744
TAX ID
—
05
—
64114101
—
KY
01
—
P00333608
RAIL ROAD MEDICARE
—
Enumeration date
01/15/2007
Last updated
03/07/2023
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