Healthcare Provider Details

I. General information

NPI: 1497271886
Provider Name (Legal Business Name): BRUCE D BULLOCK, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 COMMONS ST
RUTLAND VT
05701-4651
US

IV. Provider business mailing address

8 COMMONS ST
RUTLAND VT
05701-4651
US

V. Phone/Fax

Practice location:
  • Phone: 802-770-1805
  • Fax: 802-773-4876
Mailing address:
  • Phone: 802-770-1805
  • Fax: 802-773-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042.0008555
License Number StateVT

VIII. Authorized Official

Name: MRS. ANN M HUGHES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 802-772-1989