Individual
MR. ROBERT LEE BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
9320 S MINGO RD, TULSA, OK 74133-5710
(918) 879-1700
(918) 879-1701
Mailing address
9320 S MINGO RD, TULSA, OK 74133-5710
(918) 879-1700
(918) 879-1701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
195
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088420B
—
OK
01
—
P00283432
RAIL ROAD MEDICARE
—
Enumeration date
05/19/2006
Last updated
12/07/2015
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