Healthcare Provider Details

I. General information

NPI: 1730720970
Provider Name (Legal Business Name): DR. JENNIFER BULLOCK ALLERGY AND ASTHMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 NORTHWOODS BLVD STE 120
COLUMBUS OH
43235-4711
US

IV. Provider business mailing address

PO BOX 933377
CLEVELAND OH
44193-0038
US

V. Phone/Fax

Practice location:
  • Phone: 614-635-9606
  • Fax:
Mailing address:
  • Phone: 614-635-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BULLOCK
Title or Position: OWNER
Credential:
Phone: 614-635-9606