Provider Demographics
NPI:1134110927
Name:BULLEY, PETER BRIAN (PA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BRIAN
Last Name:BULLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7423
Mailing Address - Country:US
Mailing Address - Phone:406-294-9515
Mailing Address - Fax:406-294-9520
Practice Address - Street 1:2294 GRANT RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7423
Practice Address - Country:US
Practice Address - Phone:406-294-9515
Practice Address - Fax:406-294-9520
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT429363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMB0707426OtherDEA NUMBER
MTMB0707426OtherDEA NUMBER