Healthcare Provider Details

I. General information

NPI: 1033101712
Provider Name (Legal Business Name): ALAN REID BULLOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4582 N 1ST AVE SUITE 170
TUCSON AZ
85718-8603
US

IV. Provider business mailing address

4747 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-6035
  • Fax: 520-795-9953
Mailing address:
  • Phone: 520-731-5540
  • Fax: 520-731-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16618
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: