Provider Demographics
NPI:1124280821
Name:BULLOCK OB/GYN PA
Entity type:Organization
Organization Name:BULLOCK OB/GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-441-1170
Mailing Address - Street 1:500 MEDICAL CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2800
Mailing Address - Country:US
Mailing Address - Phone:936-441-1170
Mailing Address - Fax:936-539-6685
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2800
Practice Address - Country:US
Practice Address - Phone:936-441-1170
Practice Address - Fax:936-539-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty