MEDICARE: NICOLE C BULLOCK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	N2970	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023277076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE C BULLOCK DO

Provider Business Mailing Address
First Line	:	5750 PINELAND DR STE 240
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5300
Country	:	US
Telephone Number	:	214-221-0855
Fax Number	:	972-354-8736

Provider Business Practice Location Address
First Line	:	5750 PINELAND DR STE 240
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5300
Country	:	US
Telephone Number	:	214-221-0855
Fax Number	:	972-354-8736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	05/15/2025

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Directions to “ NICOLE C BULLOCK DO” Practice Location

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