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JOHN DAVID BULLOCK MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1942217757

Individual Registrant:
 JOHN DAVID BULLOCK MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1238 HIGHWAY 42  SUMRALL, MS 39482 US
Tel: 601-758-3100  Fax: 601-758-3008

Contact information for business:
415 S 28TH AVE  HATTIESBURG, MS 39401-7246 US
Tel: 601-758-3100  Fax: 601-579-5240

Registration Information:
NPI: 1942217757
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
MS12095

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
00121120MS05
AMERICAN ADMIN GROUP1559122MS01




HEALTH CARE JOBS MS - Page 1



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