Individual
MS. LORI BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
106 N CRITTENDEN ST, MARSHFIELD, MO 65706-1408
(417) 859-3991
(417) 859-0100
Mailing address
1911 S NATIONAL AVE, SUITE 302, SPRINGFIELD, MO 65804-2219
(417) 881-4164
(417) 881-1727
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
109731
MO
Other
Enumeration date
10/16/2006
Last updated
07/08/2007
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