Healthcare Provider Details

I. General information

NPI: 1497761720
Provider Name (Legal Business Name): MATTHEW BULOW C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID DYE MANAGER

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 E 10TH ST
COOKEVILLE TN
38501-1958
US

IV. Provider business mailing address

708 E 10TH ST
COOKEVILLE TN
38501-1958
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-0244
  • Fax: 931-520-0241
Mailing address:
  • Phone: 931-520-0244
  • Fax: 931-520-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: