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Individual

DR. FORREST A BULLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5268 W BOWSTRING WAY, SOUTH JORDAN, UT 84009-6161
(307) 760-3869
Mailing address
5268 W BOWSTRING WAY, SOUTH JORDAN, UT 84009-6161
(307) 760-3869

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
7575794-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8352718
WA
Enumeration date
12/09/2005
Last updated
12/14/2018
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