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General NPI Number Information
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NPI Number | 1063611739
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Entity Type | Individual
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Provider Name | SHAMINDER SINGH BHULLAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 11373 CORTEZ BLVD STE 400
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5414
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Country | US
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Telephone | 352-597-2604
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Fax | 352-596-0520
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Provider Business Mailing Address
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Address Line | 11373 CORTEZ BLVD STE 400
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5414
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Country | US
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Telephone | 352-597-2604
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Fax | 352-596-0520
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | P0008
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME112489
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License Number State | FL
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