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General NPI Number Information
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NPI Number | 1508872417
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Entity Type | Individual
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Provider Name | STEPHEN MARK BULLARD M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1540 LYON DR
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City | NEENAH
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State | WI
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Zip | 54956-5069
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Country | US
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Telephone | 920-727-4946
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Fax |
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Provider Business Mailing Address
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Address Line | 1369 RAHR AVE
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City | OSHKOSH
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State | WI
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Zip | 54901-5363
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Country | US
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Telephone | 920-232-9932
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 38647-020
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License Number State | WI
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