Provider Demographics
NPI:1033101712
Name:BULLOCK, ALAN REID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:REID
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 E CAMP LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1256
Mailing Address - Country:US
Mailing Address - Phone:520-731-5540
Mailing Address - Fax:520-731-5540
Practice Address - Street 1:4582 N 1ST AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8603
Practice Address - Country:US
Practice Address - Phone:520-318-6035
Practice Address - Fax:520-795-9953
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ277807Medicaid
AZ277807Medicaid
AZZ102884Medicare PIN