MEDICARE: JAMAL MORRISETTE BULLOCKS M.D.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	M5077	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134249451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMAL MORRISETTE BULLOCKS M.D.

Provider Business Mailing Address
First Line	:	2813 WTC JESTER BLVD.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-7004
Country	:	US
Telephone Number	:	713-715-7083
Fax Number	:	866-224-6704

Provider Business Practice Location Address
First Line	:	2813 WTC JESTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-7004
Country	:	US
Telephone Number	:	713-715-7083
Fax Number	:	866-224-6704

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	10/05/2021

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