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General NPI Number Information
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NPI Number | 1134249451
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Entity Type | Individual
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Provider Name | JAMAL MORRISETTE BULLOCKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 2813 WTC JESTER BLVD
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City | HOUSTON
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State | TX
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Zip | 77018-7004
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Country | US
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Telephone | 713-715-7083
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Fax | 866-224-6704
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Provider Business Mailing Address
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Address Line | 2813 WTC JESTER BLVD.
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City | HOUSTON
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State | TX
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Zip | 77018-7004
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Country | US
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Telephone | 713-715-7083
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Fax | 866-224-6704
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | M5077
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License Number State | TX
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