Individual
DR. PETER PAUL BULLOCK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
106 S CASTLEROCK LN, MUSTANG, OK 73064-4586
(405) 256-0374
Mailing address
106 S CASTLEROCK LN, MUSTANG, OK 73064-4586
(405) 256-0374
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25803
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25803
OKLAHOMA MEDICAL LICENSE
OK
Enumeration date
07/23/2008
Last updated
07/06/2011
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