1306948898 NPI number — DR. GARY MORGAN BULLOCK D.O.

Table of content: DR. GARY MORGAN BULLOCK D.O. (NPI 1306948898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306948898 NPI number — DR. GARY MORGAN BULLOCK D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLOCK
Provider First Name:
GARY
Provider Middle Name:
MORGAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1306948898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 EMORY DRIVE
Provider Second Line Business Mailing Address:
STE 700
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-987-4044
Provider Business Mailing Address Fax Number:
205-987-4966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 EMORY DRIVE
Provider Second Line Business Practice Location Address:
STE 700
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-987-4044
Provider Business Practice Location Address Fax Number:
205-987-4966
Provider Enumeration Date:
09/04/2006

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: 207Q00000X , with the licence number:  DO-729 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50369 . This is a "SENIORS FIRST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0112855 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051539246 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009941834 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: H44865 . This is a "VIVA HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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