Healthcare Provider Details

I. General information

NPI: 1841504875
Provider Name (Legal Business Name): YVONNE BULLARD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH ST STE 606
PANAMA CITY FL
32401-3645
US

IV. Provider business mailing address

801 E 6TH ST STE 606
PANAMA CITY FL
32401-3645
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-2229
  • Fax: 850-785-1806
Mailing address:
  • Phone: 850-785-2229
  • Fax: 850-785-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0053167
License Number StateFL

VIII. Authorized Official

Name: YVONNE BULLARD
Title or Position: PHYSICIAN
Credential: MD
Phone: 850-785-2229