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NPI Code Detail

MEDICARE: LYNN BULLOCK MD

MEDICARE:   LYNN  BULLOCK  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
1208000000XPediatrics Physician36874CO

General Provider Information

NPI Number : 1558313536
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN BULLOCK MD
Provider Business Mailing Address
First Line : 3207 N ACADEMY BLVD
Second Line : SUITE 300
City : COLORADO SPRINGS
State : CO
Zip : 80917-5100
Country : US
Telephone Number : 719-597-8704
Fax Number : 719-597-6864
Provider Business Practice Location Address
First Line : 3207 N ACADEMY BLVD
Second Line : SUITE 300
City : COLORADO SPRINGS
State : CO
Zip : 80917-5100
Country : US
Telephone Number : 719-597-8704
Fax Number : 719-597-6864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/08/2007

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Directions to “ LYNN BULLOCK MD” Practice Location

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