Individual
DR. LARRY AJOLO BULAHAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2441 NACOGDOCHES RD, # 806, SAN ANTONIO, TX 78217-6044
(210) 859-7718
Mailing address
2441 NACOGDOCHES RD, # 806, SAN ANTONIO, TX 78217-6044
(210) 599-3008
(210) 599-6175
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
1606
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157842901
—
TX
05
—
157844502
—
TX
01
—
P00216950
RR MEDICARE
TX
01
—
P00450858
RR MEDICARE
TX
Enumeration date
07/19/2006
Last updated
03/02/2016
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