Provider Demographics
NPI:1992328827
Name:BHULLAR, HARYASHPAL (DO)
Entity type:Individual
Prefix:
First Name:HARYASHPAL
Middle Name:
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6029
Mailing Address - Country:US
Mailing Address - Phone:850-494-3953
Mailing Address - Fax:850-494-3950
Practice Address - Street 1:2191 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6029
Practice Address - Country:US
Practice Address - Phone:850-494-3953
Practice Address - Fax:850-494-3950
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-07-01
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-05-17
Provider Licenses
StateLicense IDTaxonomies
FLOS197342084P0800X
FL7432390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry