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General NPI Number Information
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NPI Number | 1548590557
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Entity Type | Organization
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Legal Business Name | BULLOCKS PLASTIC SURGERY, P.L.L.C.
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 9122 KAPRI LN
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City | HOUSTON
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State | TX
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Zip | 77025-4202
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Country | US
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Telephone | 713-218-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 WEST HOLCOMBE BLVD SUITE 179
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City | HOUSTON
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State | TEXAS
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Zip | 77030
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Country | UM
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Telephone | 713-218-9100
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Fax | 713-665-8873
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JAMAL BULLOCKS
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Credential | M.D.
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Telephone | 713-218-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | M5077
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License Number State | TX
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