Individual
LANCE EVERETT BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3136 S SAINT LANDRY AVE, GONZALES, LA 70737-5801
(225) 647-7524
Mailing address
37459 ULTIMA PLAZA BLVD STE B-227, PRAIRIEVILLE, LA 70769-3856
(225) 673-8258
(225) 673-2340
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
09761R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1683728
—
LA
Enumeration date
07/11/2007
Last updated
05/21/2009
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