Individual
SAMUEL WILLIAM BULLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-8407
(503) 413-6951
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
LL158520
OR
207RP1001X
Pulmonary Disease Physician
Primary
DO188659
OR
Other
Enumeration date
05/21/2012
Last updated
09/05/2018
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