MEDICARE: DR. BRANCH RICKEY BULLARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	27386	OK
2	207Q00000X	Family Medicine Physician	27386	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104804137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANCH RICKEY BULLARD MD

Provider Business Mailing Address
First Line	:	34 SW 89TH ST STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-8510
Country	:	US
Telephone Number	:	405-488-0750
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 SW 89TH ST STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-8510
Country	:	US
Telephone Number	:	405-488-0750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	10/18/2024

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