Individual
MR. ROBERT TED LEWIS BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1215 NW 25TH ST, OKLAHOMA CITY, OK 73106-5629
(405) 525-2525
(405) 600-3105
Mailing address
1215 NW 25TH ST, OKLAHOMA CITY, OK 73106-5629
(405) 525-2525
(405) 600-3105
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
65061
OK
Other
Enumeration date
08/21/2016
Last updated
08/21/2016
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