1275554115 NPI number — DR. JOHN L BULETTE M.D.

Table of content: DR. JOHN L BULETTE M.D. (NPI 1275554115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275554115 NPI number — DR. JOHN L BULETTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULETTE
Provider First Name:
JOHN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275554115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASSAWADOX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23413-0733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-442-2504
Provider Business Mailing Address Fax Number:
757-442-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10150 ROGERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASSAWADOX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23413-0733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-442-2504
Provider Business Practice Location Address Fax Number:
757-442-9099
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0101051010 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 068468 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 089844 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 265784 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 265784 . This is a "MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 265784 . This is a "ALLIANCE,PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 214354 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 214354 . This is a "HEALTHKEEPERS PLUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 265784 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 214354 . This is a "HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".