Individual
DR. JUSTIN REEVES BULAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1 CHILDRENS PL, SAINT LOUIS, MO 63110
(314) 454-6148
(314) 454-4633
Mailing address
1 CHILDRENS PL, MSC 8515-87-1200, SAINT LOUIS, MO 63110
(314) 454-6148
(314) 454-4633
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2017010897
MO
208000000X
Pediatrics Physician
OS015778
PA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
2017010897
MO
2080N0001X
Neonatal-Perinatal Medicine Physician
OS015778
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IL
Enumeration date
06/25/2008
Last updated
03/25/2020
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