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General NPI Number Information
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NPI Number | 1033101712
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Entity Type | Individual
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Provider Name | ALAN REID BULLOCK MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 4582 N 1ST AVE SUITE 170
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City | TUCSON
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State | AZ
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Zip | 85718-8603
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Country | US
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Telephone | 520-318-6035
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Fax | 520-795-9953
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Provider Business Mailing Address
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Address Line | 4747 E CAMP LOWELL DR
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City | TUCSON
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State | AZ
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Zip | 85712-1256
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Country | US
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Telephone | 520-731-5540
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Fax | 520-731-5540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16618
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License Number State | AZ
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