Provider Demographics
NPI:1528667045
Name:BULOT, RAYMOND GEORGE
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:GEORGE
Last Name:BULOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 W PALM LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-2902
Mailing Address - Country:US
Mailing Address - Phone:602-487-9021
Mailing Address - Fax:
Practice Address - Street 1:2331 W PALM LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2902
Practice Address - Country:US
Practice Address - Phone:602-487-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)