Organization
KENNETH JAMES BULEY MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH JAMES BULEY MD (OWNER)
(817) 370-8833
Entity
Organization
Contact information
Practice address
6551 HARRIS PARKWAY, SUITE 110, FORT WORTH, TX 76132-6105
(817) 370-8833
(817) 370-8852
Mailing address
PO BOX 164009, FORT WORTH, TX 76161
(817) 370-8833
(817) 370-8852
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0093DH
BCBS
TX
05
—
179438001
—
TX
Enumeration date
03/28/2006
Last updated
07/25/2012
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