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General NPI Number Information
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NPI Number | 1386638286
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Entity Type | Individual
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Provider Name | WILLIAM JENNISON BULKLEY MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 1000 W KINGSHIGHWAY STE 3
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City | PARAGOULD
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State | AR
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Zip | 72450-4141
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Country | US
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Telephone | 870-240-8020
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Fax | 870-240-8028
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Provider Business Mailing Address
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Address Line | PO BOX 579 1000 W KINGS HWY STE 3
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City | PARAGOULD
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State | AR
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Zip | 72451-0579
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Country | US
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Telephone | 870-240-8020
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Fax | 870-240-8028
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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 | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | E1362
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 110242
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | K6995
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License Number State | TX
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