Organization
NEW ALBANY SURGICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE ALLAN BULLWINKEL M.D. (PHYSICIAN)
(662) 534-8159
Entity
Organization
Contact information
Practice address
226 STARLYN AVE, NEW ALBANY, MS 38652-2428
(662) 534-8159
Mailing address
226 STARLYN AVE, P.O. BOX 891, NEW ALBANY, MS 38652-2428
(662) 534-8159
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
8661
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09011230
—
MS
Enumeration date
10/05/2006
Last updated
11/28/2007
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