Individual
DR. MICHAEL BRENT BULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
110 W 1325 N STE 200, CEDAR CITY, UT 84721-8179
(435) 586-7676
Mailing address
110 W 1325 N STE 200, CEDAR CITY, UT 84721-8179
(435) 586-7676
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
94725281204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700149804
—
UT
Enumeration date
06/22/2012
Last updated
10/22/2024
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