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JOHN DAVID BULLOCK MD
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1942217757
Individual Registrant: JOHN DAVID BULLOCK MD
Gender: M
Not Sole Proprietor
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
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
Tel: 601-758-3100 Fax: 601-579-5240
Registration Information:
NPI: 1942217757
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | MS | 12095 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 00121120 | MS | 05 | |
| AMERICAN ADMIN GROUP | 1559122 | MS | 01 |
