Individual
MR. KENNETH J BULEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6551 HARRIS PKWY, SUITE 110, FORT WORTH, TX 76132-6105
(817) 370-8833
(817) 370-8852
Mailing address
PO BOX 164009, FORT WORTH, TX 76161-4009
(817) 370-8833
(817) 370-8852
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J4012
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0093DH
BCBS
TX
05
—
113742404
—
TX
Enumeration date
03/22/2006
Last updated
07/25/2012
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