MEDICARE: DR. KENNETH HAROLD BULL 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	2084P0800X	Psychiatry Physician	73-99	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	347735502	OTHER	NM	MEDICARE PTAN

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	:	1700808672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH HAROLD BULL M.D.

Provider Business Mailing Address
First Line	:	3500 COMANCHE RD NE
Second Line	:	BLDG E6
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4546
Country	:	US
Telephone Number	:	505-881-8666
Fax Number	:	505-881-3261

Provider Business Practice Location Address
First Line	:	3500 COMANCHE RD NE
Second Line	:	BLDG E6
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4546
Country	:	US
Telephone Number	:	505-881-8666
Fax Number	:	505-881-3261

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	06/25/2014

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Directions to “ DR. KENNETH HAROLD BULL M.D.” Practice Location

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