Individual
EDWIN BULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
150 W 100 N, VERNAL, UT 84078-2036
(207) 659-8810
Mailing address
827 W 350 S, VERNAL, UT 84078-2941
(207) 659-8810
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5419392-4406
UT
367500000X
Certified Registered Nurse Anesthetist
AA103013
ME
Other
Enumeration date
07/16/2010
Last updated
05/29/2012
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