Individual
ROSE MARIE SHAW-BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 W PERSHING BLVD, N LITTLE ROCK, AR 72114-2146
(501) 771-7717
(501) 771-0550
Mailing address
400 W PERSHING BLVD, N LITTLE ROCK, AR 72114-2146
(501) 771-7717
(501) 771-0550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E0873
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132896001
—
AR
Enumeration date
04/14/2006
Last updated
08/02/2010
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