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Individual

KEITH A BULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3000
Mailing address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3000

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200007.RX
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
GA
Enumeration date
08/03/2006
Last updated
01/04/2013
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