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NPI Code Detail

MEDICARE: KEITH A BULLER P.A.

MEDICARE: KEITH A BULLER P.A.
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
1363A00000XPhysician AssistantPA.200007.RXLA

Other Identifiers

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

General Provider Information

NPI Number : 1730197211
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH A BULLER P.A.
Provider Business Mailing Address
First Line : 1701 OAK PARK BLVD
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-8911
Country : US
Telephone Number : 337-494-3000
Fax Number :
Provider Business Practice Location Address
First Line : 1701 OAK PARK BLVD
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-8911
Country : US
Telephone Number : 337-494-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 01/04/2013

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Directions to “ KEITH A BULLER P.A.” Practice Location

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