| Doctor Name: | CHARLES RAY BULLOCK |
| NPI Number: | 1023169554 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 2266 Ne Mcdaniel Ln Mcminnville, OR - 971283247 |
| Business Phone Number: | 5034352083 |
| Business Fax Number: | |
| Mailing Address: | 16425 Old Condor Bridge Rd, CLOVERDALE |
| State: | OR |
| Postal Code: | 971129658 |
| Phone Number: | 5034352083 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |