Individual
CHARLES BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4128 E 28TH PL, TULSA, OK 74114-6202
(918) 408-9206
Mailing address
401 E BROADWAY CT STE E, SAND SPRINGS, OK 74063-7931
(918) 492-2554
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3074
—
OK
Enumeration date
04/12/2022
Last updated
04/12/2022
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