Bullock, Randy A

Bullock, Randy A is an individual health care provider with primary practice located at 237 26Th St , Ogden UT 84401-3105. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Bullock, Randy A can be contacted via phone (801) 625-3605.

Contact Information

Primary practice address
237 26Th St Ogden UT 84401-3105
Phone: (801) 625-3605
Fax: (801) 625-3615
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 1996264405 Utah
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 8900CS Utah

Profile Details

NPI number 1528099231
LBN Legal business name Bullock, Randy A
Credentials APRN W PP SUB
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528099231 NPPES
Utah MEDICAID 876000308007

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