Individual
DR. TRAVIS SHANE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 450-9300
Mailing address
2623 OBERA WAY, SAN ANTONIO, TX 78228-3411
(210) 709-3434
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
725298
TX
Other
Enumeration date
04/27/2021
Last updated
04/27/2021
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