Individual
DR. PONCE D BULLARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2728 SUNSET BLVD, SUITE 310, WEST COLUMBIA, SC 29169
(803) 936-8080
(803) 936-8079
Mailing address
2728 SUNSET BLVD, SUITE 310, WEST COLUMBIA, SC 29169
(803) 936-8080
(803) 936-8079
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
7127
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071273
—
SC
01
—
990011971
RR MEDICARE
—
Enumeration date
07/21/2006
Last updated
08/24/2012
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