Provider Demographics
NPI:1104816735
Name:BULLARD, ARLEAN MICHELLE (MD)
Entity type:Individual
Prefix:MRS
First Name:ARLEAN
Middle Name:MICHELLE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15655 CYPRESS WOODS MEDICAL DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014
Mailing Address - Country:US
Mailing Address - Phone:281-580-7004
Mailing Address - Fax:281-921-1166
Practice Address - Street 1:15655 CYPRESS WOODS MEDICAL DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014
Practice Address - Country:US
Practice Address - Phone:281-580-7004
Practice Address - Fax:281-921-1166
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
87416ZOtherHMO BLUE
80433YOtherBCBS
8525K3Medicare ID - Type Unspecified
TXH44302Medicare UPIN