Individual
MR. GARY PHILLIP BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4566 E HIGHWAY 20 STE 105, NICEVILLE, FL 32578-8839
(850) 279-4543
(850) 279-4827
Mailing address
4566 E HIGHWAY 20 STE 105, NICEVILLE, FL 32578-8839
(850) 279-4543
(850) 279-4827
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0010-00280
NC
363AM0700X
Medical Physician Assistant
Primary
PA9104382
FL
Other
Enumeration date
02/23/2006
Last updated
01/06/2021
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