MEDICARE: DR. ROBERT L BULL JR. MD

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	207Q00000X	Family Medicine Physician	158870	NY

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	:	1568467876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L BULL JR. MD

Provider Business Mailing Address
First Line	:	5320 MILITARY RD
Second Line	:	STE 106
City	:	LEWISTON
State	:	NY
Zip	:	14092-2149
Country	:	US
Telephone Number	:	716-298-5433
Fax Number	:	716-298-5434

Provider Business Practice Location Address
First Line	:	5320 MILITARY RD
Second Line	:	STE 106
City	:	LEWISTON
State	:	NY
Zip	:	14092-2149
Country	:	US
Telephone Number	:	716-298-5433
Fax Number	:	716-298-5434

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/14/2007

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