Healthcare Provider Details

I. General information

NPI: 1942331558
Provider Name (Legal Business Name): MALCOLM I BULL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 RUSSELL CIR
ANCHORAGE AK
99507-6755
US

IV. Provider business mailing address

7220 RUSSELL CIR
ANCHORAGE AK
99507-6755
US

V. Phone/Fax

Practice location:
  • Phone: 907-868-7864
  • Fax:
Mailing address:
  • Phone: 907-868-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberJ0924
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberAK 5038
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: