Provider Demographics
NPI:1366424160
Name:BULLEN, JAMES D (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:BULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:816 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4225
Mailing Address - Country:US
Mailing Address - Phone:405-743-0550
Mailing Address - Fax:405-743-1704
Practice Address - Street 1:816 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4225
Practice Address - Country:US
Practice Address - Phone:405-743-0550
Practice Address - Fax:405-743-1704
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK137412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE29240Medicare UPIN