1356327266 NPI number — DR. JOHN BULLMASTER

Table of content: DR. JOHN BULLMASTER (NPI 1356327266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356327266 NPI number — DR. JOHN BULLMASTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLMASTER
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1356327266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PRESTIGE PL STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-6115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-762-1310
Provider Business Mailing Address Fax Number:
937-522-8068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 WYOMING ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-2740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-228-0789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

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: 208600000X , with the licence number:  35046302 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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