Healthcare Provider Details

I. General information

NPI: 1598935249
Provider Name (Legal Business Name): NEAL M BULLOCK DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17013 PINES BLVD
PEMBROKE PINES FL
33027-1003
US

IV. Provider business mailing address

17013 PINES BLVD
PEMBROKE PINES FL
33027-1003
US

V. Phone/Fax

Practice location:
  • Phone: 954-450-4200
  • Fax: 954-450-4237
Mailing address:
  • Phone: 954-450-4200
  • Fax: 954-450-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2571
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. NEAL M BULLOCK
Title or Position: PRESIDENT OWNER
Credential: DPM
Phone: 954-450-4200