MEDICARE: ERIC J BULLER PA-C

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	363AM0700X	Medical Physician Assistant	A10253	LA

General Provider Information

NPI Number	:	1467423509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC J BULLER PA-C

Provider Business Mailing Address
First Line	:	4809 AMBASSADOR CAFFERY PKWY
Second Line	:	STE 230
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-8800
Country	:	US
Telephone Number	:	337-235-7898
Fax Number	:	337-235-7445

Provider Business Practice Location Address
First Line	:	4809 AMBASSADOR CAFFERY PKWY STE 230
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-8800
Country	:	US
Telephone Number	:	337-470-2739
Fax Number	:	337-470-6495

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	02/22/2023

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