Healthcare Provider Details

I. General information

NPI: 1376532846
Provider Name (Legal Business Name): RONALD D BULLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER BLVD
ADA OK
74820-3439
US

IV. Provider business mailing address

1921 STONECIPHER BLVD
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-3980
  • Fax:
Mailing address:
  • Phone: 580-436-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16981
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: