Doctor Name: | FRED BULLARD |
NPI Number: | 1811260383 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MT |
License Number: | 1392 |
Business Practice Address: | 669 Agency Main St Harlem, MT - 595269455 |
Business Phone Number: | 4063533100 |
Business Fax Number: | 4063533229 |
Mailing Address: | 669 Agency Main St, HARLEM |
State: | MT |
Postal Code: | 595269455 |
Phone Number: | 4063533100 |
Fax Number: | 4063533229 |
NPI Enumeration Date: | 02/14/2012 |
NPI Last Update Date: | 02/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246RM2200X |
License Number: | 1392 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Technician, Pathology |
Taxonomy Specialization: | Medical Laboratory |
Taxonomy Definition: |