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General NPI Number Information
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NPI Number | 1457381220
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Entity Type | Individual
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Provider Name | MALCOLM R BULLOCK M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 1475 NW 12TH AVE NEUROSURGERY
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City | MIAMI
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State | FL
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Zip | 33136-1002
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Country | US
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Telephone | 305-243-6946
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Fax | 305-243-3337
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Provider Business Mailing Address
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Address Line | 1095 NW 14TH TER 2ND FLOOR
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City | MIAMI
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State | FL
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Zip | 33136-1060
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Country | US
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Telephone | 305-243-6946
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Fax | 305-243-3337
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 0101058845
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License Number State | VA
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