MEDICARE: RAYMOND GEORGE BULOT

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1528667045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND GEORGE BULOT

Provider Business Mailing Address
First Line	:	2331 W PALM LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-2902
Country	:	US
Telephone Number	:	602-487-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 W PALM LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-2902
Country	:	US
Telephone Number	:	602-487-9021
Fax Number	:

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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Directions to “ RAYMOND GEORGE BULOT ” Practice Location

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