Provider Demographics
NPI:1063578540
Name:BULLS, CLAYTON PATRICK (PA-C)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:PATRICK
Last Name:BULLS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 REGIONAL PLZ
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5250
Mailing Address - Country:US
Mailing Address - Phone:325-690-1805
Mailing Address - Fax:325-690-6145
Practice Address - Street 1:6200 REGIONAL PLZ
Practice Address - Street 2:SUITE 1200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5250
Practice Address - Country:US
Practice Address - Phone:325-690-1805
Practice Address - Fax:325-690-6145
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03531363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20132065OtherTX DPS REGIST. NO.
TXPA03531OtherSTATE LICENSE
TX116581301Medicaid
TX8B3965Medicare PIN