Individual
DR. LARRY AJOLO BULAHAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
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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