Individual
KENNETH PENN BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1225 CHARTER PLACE, CHARLOTTE, NC 28211-5503
(704) 364-2358
Mailing address
1225 CHARTER PLACE, CHARLOTTE, NC 28211-5503
(704) 364-2358
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
15028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19723
BLUE CROSS BLUE SHIELD
NC
05
—
360677
—
SC
05
—
8919723
—
NC
Enumeration date
12/12/2006
Last updated
07/08/2007
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