Individual
RANDY A BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN W PP SUB
Contact information
Practice address
237 26TH ST, OGDEN, UT 84401-3105
(801) 625-3605
(801) 625-3615
Mailing address
237 26TH ST, OGDEN, UT 84401-3105
(801) 625-3605
(801) 625-3615
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1996264405
UT
363L00000X
Nurse Practitioner
8900CS
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876000308007
—
UT
Enumeration date
07/05/2006
Last updated
07/08/2007
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