Provider Demographics
NPI:1306948898
Name:BULLOCK, GARY MORGAN (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MORGAN
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:430 EMORY DRIVE
Mailing Address - Street 2:STE 700
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-987-4044
Mailing Address - Fax:205-987-4966
Practice Address - Street 1:430 EMORY DRIVE
Practice Address - Street 2:STE 700
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-987-4044
Practice Address - Fax:205-987-4966
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO-729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL50369OtherSENIORS FIRST
AL0112855OtherMEDICARE COMPLETE
AL051539246OtherBLUE CROSS
AL009941834Medicaid
ALH44865OtherVIVA HEALTH
AL0112855OtherMEDICARE COMPLETE
ALH44865OtherVIVA HEALTH