Provider Demographics
NPI:1154383503
Name:BULLARD, ANDREW GRAY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GRAY
Last Name:BULLARD
Suffix:
Gender:M
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:WAKE FOREST BAPTIST MEDICAL CENTER
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32654207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2460072/5678036OtherAETNA
12338OtherPARTNERS
298485OtherMAMSI
NC890109NMedicaid
NC19674OtherBCBS
NC32654OtherNC MEDICAL BOARD
1516879-003OtherCIGNA
290005714OtherRAILROAD MEDICARE
311001OtherCOVENTRY
4840048OtherUNITED HEALTHCARE
4840048OtherUNITED HEALTHCARE
NC19674OtherBCBS
298485OtherMAMSI