Healthcare Provider Details

I. General information

NPI: 1467423509
Provider Name (Legal Business Name): ERIC J BULLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 AMBASSADOR CAFFERY PKWY STE 230
LAFAYETTE LA
70508-8800
US

IV. Provider business mailing address

4809 AMBASSADOR CAFFERY PKWY STE 230
LAFAYETTE LA
70508-8800
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2739
  • Fax: 337-470-6495
Mailing address:
  • Phone: 337-235-7898
  • Fax: 337-235-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA10253
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: