Organization
PETER BULLOCK MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER BULLOCK M.D. (OWNER)
(405) 256-6000
Entity
Organization
Contact information
Practice address
206 N MUSTANG MALL TER, MUSTANG, OK 73064-5135
(405) 256-6000
(405) 256-6001
Mailing address
206 N MUSTANG MALL TER, MUSTANG, OK 73064-5135
(405) 256-6000
(405) 256-6001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OK
Enumeration date
06/17/2010
Last updated
06/17/2010
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