Individual
RONALD A BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 PARKWAY LN, PETAL, MS 39465-3035
(601) 705-2897
(601) 584-6457
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5610
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
09600
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019948
—
MS
01
—
1558922
AMERICAN ADMIN GROUP
MS
05
—
1589608
—
LA
01
—
220002394
RAILROAD MEDICARE
—
01
—
P00618852
RAILROAD MEDICARE
MS
Enumeration date
08/01/2006
Last updated
05/31/2024
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