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General NPI Number Information
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NPI Number | 1134571433
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Entity Type | Individual
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Provider Name | MARK ANDREW LESLIE BULLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 350 W THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85013-4409
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Country | US
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Telephone | 602-406-7783
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Fax |
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Provider Business Mailing Address
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Address Line | 16210 S 17TH LN
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City | PHOENIX
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State | AZ
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Zip | 85045-1761
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Country | US
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Telephone | 780-916-3852
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Fax |
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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 | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | R75762
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License Number State | AZ
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