Provider Demographics
NPI:1316494271
Name:BULL, DAVID EUGENE (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:BULL
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 1:3330 PEACH ST STE 106B
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2771
Mailing Address - Country:US
Mailing Address - Phone:630-886-8459
Mailing Address - Fax:
Practice Address - Street 1:3330 PEACH ST STE 106B
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2771
Practice Address - Country:US
Practice Address - Phone:814-787-7155
Practice Address - Fax:814-787-7155
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061813363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical